Rhettsgirl: small decrease causing havoc?

January 20, 2013

Hi! I hope someone has some advice or comfort for me. I have been taking 80mg of Nortriptyline since April of 2004. When our insurance was changing this January, I decided (with the support of my doctor) to decrease to 75mg for cost reasons. I decreased from 80mg to 75mg on January 2nd and actually felt fine. My doctor didn't anticipate any problems for me at all. However, I have been increasingly anxious starting on day 15 through today.I have felt constant anxiety which won't go away even when I'm concentrating on something else.

I felt this way while first taking antidepressants 9 years ago. I was going through postpartum anxiety and depression at the time. I couldn't sleep or function and everyone involved felt that antidepressants were the answer. I felt horrible the third day taking antidepressants and felt the anxiety like I am feeling now. Constant panicky feelings that just won't go away. Everyone said that that was normal when first starting an antidepressant and I should continue. I think it probably took 9 months to a year or longer to finally feel semi normal.

Back to today. I can't believe that a decrease of only 5mg could bring about such horrible feelings. After I reached the two week mark without much problem, I thought I was home free. Now this. Will this go away in time or should I switch back to 80mg? Will going back to 80mg cause even more havoc since my body is trying to adjust to 75mg?

Any advice would be appreciated!!

Thanks!

January 20, 2013

Hi rhettsgirl's

Welcome to the forum

So sorry to hear you are suffering at present, I'm not able to advise you on this matter but you have come to the right place.

There are many experienced helpful people on this site who will be along soon to advise you.

I do hope you will be feeling better soon

Debbie x

January 20, 2013

Thank you so much for replying! I really need encouragement. My husband can't believe I could possibly feel this bad from such a small dose change.

I hope someone will give me some advice soon!

January 20, 2013

Hi Rhettsgirl,

Welcome to our community. If I am reading this correctly you have only been on the lower dose for 19 days. Did you feel well and stable at 80 mg?

I'm not familiar with Nortriptyline specifically, but based on my experience and observations with antidepressants in general I would recommend that you reinstate back to your dose of 80 mg to see if you have any relief from your symptoms.

Although the 5 mg decrement is well within our recommended 10% dose reduction it appears that your system is not ready for a reduction of this medication. Reinstatement is the only response medicine has recommended to withdrawal symptoms and you are within the range for reinstating back to the last dose at which you felt well.

Other mods will be along shortly and may have more knowledge of your specific med.

Karma

January 20, 2013

I agree with Karma that it's probably best to go back to 80 mg., stabililize, and then taper at a slower pace. Nortriptyline is available as a liquid, which would allow you to decrease in small amounts. I'm not familiar with this particular drug, but our administrator, Altostrata, will be better able to advise you and I expect she'll be signing on sometime today.

It's good that your doctor is supportive of your getting off the antidepressant, but please be advised that most doctors are not at all familiar with antidepressant withdrawal syndrome and don't know what to do about it.

Welcome to the forum. There's lots of good information and friendly, supportive people here. You might want to browse the topics under the 'Tapering' discussion:

Tapering

January 20, 2013

Bless you for responding! Yes, I felt fine on the 80mg.

I think I will go back to the 80mg and call my doctor tomorrow. I am afraid he's going to think I am crazy for having such a bad reaction to the small dose decrease. I am concerned he won't believe me and say that it's all in my head.

I look forward to seeing other people's responses as well and I am thankful that you have taken the time to respond to me. I will explore this board in more detail today.

If anyone would care to offer up a prayer for me, I would appreciate that as well.

Thank you so much!

January 20, 2013

Welcome, Rhettsgirl.

Some people are sensitive to very small decreases in their medication. You may be one of them.

You might want to go back to 80mg, stabilize, then reduce by 1mg at a time to get to 75mg. Since it takes 2 weeks for you to feel withdrawal symptoms, try a 1mg reduction every 3 weeks. Go slower if you feel withdrawal symptoms.

Don't discount the power of these drugs, or the degree of physical dependency they cause. A sensitive person might feel a decrease of 5mg or even 1mg.

January 21, 2013

Thanks again, everyone! I'll keep you posted.

January 24, 2013

I'm looking forward to hearing how this goes...

And also I'm wondering - what plans are you making for learning new ways to deal with anxiety as it occurs?

As I taper I'm trying to build a habit of daily yoga/meditation/prayer. It helps me a lot. What are you doing? Everyone has to find ways to deal with anxiety - I see lots of unmedicated people who deal with anxiety in their lives in both good and REALLY BAD ways. When you naturally have more anxiety, you have to take more measures to deal with it. I would suggest putting a lot of thought into this before you start tapering again.

January 24, 2013

Welcome I've been here only three days and feel very supported. Reducing antidepressants is a little piece of hell on earth. I am saving money to see a professional hypnotist in Pittsburgh, where I live, he is very well reguarded for helping with anxiety. I want to do as much as I can not medically from now on. I have changed my diet a bit to flood my brain with more nutrients.

I'm hope you can get back on track and feeling like your old self.

Linda

January 25, 2013

As I taper I'm trying to build a habit of daily yoga/meditation/prayer. It helps me a lot. What are you doing? Everyone has to find ways to deal with anxiety - I see lots of unmedicated people who deal with anxiety in their lives in both good and REALLY BAD ways. When you naturally have more anxiety, you have to take more measures to deal with it. I would suggest putting a lot of thought into this before you start tapering again.

You might want to browse this topic:

Neuroplasticity and limbic retraining

Yoga, meditation, and prayer are excellent ways to retrain your anxious mind. I'm currently reading The Mindful Way Through Depression which is all about focusing on the here and now using meditational techniques, and I'm not sure what else, since I'm not done with the book. It's helping, and I expect it may help steer me away from anxiety and depression in the future.

February 5, 2013

Well!

I tried going back to 80mg - ended up having worse anxiety symptoms! I was sitting at my desk at work feeling like I was losing my mind. I called my doctor in a panic and he told me that in the long run I'd be better off at the lower dose of 75mg and to stick with it. He told me to stop thinking about lowering my dosage because I was causing my anxiety.

What!? I agree I am a worrier, but what no one ever seemed to believe was how horribly agitated I was when I first started on this stuff. It took me a couple of years to finally get to a degree of feeling calm again. I'm assuming this was my nervous system repairing itself. Now, this change - down to 75mg has brought back a lot of similar feelings (and bad memories) of when I first began the Nortriptyline. These past two weeks have been really painful!

Wingbatty - I wish I had had a better plan before I started decreasing this medication. I truly thought I had a lot of coping mechanisms and I didn't expect to feel much anxiety with such a small dose change.

Jemima - I am definitely going to look at the link you recommended about neuroplasticity and limbic retraining.

Thank you a thousand times for responding! You are such a nice group and I am so thankful for you and this board! I am planning with my next payday to make a donation. Thank you again!

February 5, 2013

Okay, it looks like your nervous system is getting used to 75mg.

It seem nortriptyline was always too activating for you. This is an adverse effect some people experience. It's not beneficial.

Think in terms of 1mg decreases, every few weeks, to minimize withdrawal symptoms.

February 11, 2013

An update. I'm honestly surprised that I still feel rotten. Believe me, I'm not concentrating on feeling rotten. I'm doing all the things I normally would. Yesterday, I ran errands (fun errands that I didn't mind doing) and then I learned to cook an Indian meal with my next door neighbor. However, toward the evening, all the excitement - even though it was good excitement - caught up with me. I felt overwhelmed and as if I had consumed cup after cup of coffee. I stayed at my neighbor's house and we ate and I tried to act as normal as possible, but I just felt really sick and like I wanted to go home.

Last night I did some yoga relaxation and breathing around 11:00 and finally fell asleep maybe 11:45. I woke up at 4:45 feeling panicky. Today we went to church and I made truffles for Valentine's Day, but I've been feeling yucky and hyper. My husband is very supportive. I am so thankful for that!

Has anyone experienced what I am? I just feel hyper all the time, a little sick to my stomach and even good excitement feels too stimulating. I'm beginning to feel like I'm losing energy. I do remember feeling this way when I first started on the antidepressants. I am just trying to remember that I gradually felt better and I pray that that is what will happen this time around. If I can stabilize on 75mg, I don't think I'm ever going to try to change again. I'm just losing so much enjoyment out of my life.

Does anyone else feel like this - super hyper and wired, but like you've been through the wringer? I've lost about 4 pounds or so. That's the only silver lining I can come up with at this point.

Thanks for listening. I look forward to hearing from you. Is this the right place to post or should I be making a new one?

February 11, 2013

An update. I'm honestly surprised that I still feel rotten. Believe me, I'm not concentrating on feeling rotten. I'm doing all the things I normally would. Yesterday, I ran errands (fun errands that I didn't mind doing) and then I learned to cook an Indian meal with my next door neighbor. However, toward the evening, all the excitement - even though it was good excitement - caught up with me. I felt overwhelmed and as if I had consumed cup after cup of coffee. I stayed at my neighbor's house and we ate and I tried to act as normal as possible, but I just felt really sick and like I wanted to go home.

Last night I did some yoga relaxation and breathing around 11:00 and finally fell asleep maybe 11:45. I woke up at 4:45 feeling panicky. Today we went to church and I made truffles for Valentine's Day, but I've been feeling yucky and hyper. My husband is very supportive. I am so thankful for that!

Has anyone experienced what I am? I just feel hyper all the time, a little sick to my stomach and even good excitement feels too stimulating. I'm beginning to feel like I'm losing energy. I do remember feeling this way when I first started on the antidepressants. I am just trying to remember that I gradually felt better and I pray that that is what will happen this time around. If I can stabilize on 75mg, I don't think I'm ever going to try to change again. I'm just losing so much enjoyment out of my life.

Does anyone else feel like this - super hyper and wired, but like you've been through the wringer? I've lost about 4 pounds or so. That's the only silver lining I can come up with at this point.

Thanks for listening. I look forward to hearing from you. Is this the right place to post or should I be making a new one?

rettsgirl, yes what you describe is something I experienced just this fall when I , similarly to you, began to reduce my dosage of AD and at the same time or close to it, readjust the dosing schedule of another drug. Things like visiting, going to a basketball game with loud noises, a band etc after getting home I would just feel like I was vibrating or buzzing. In addition, waking up earlier than normal happened sometimes when that was never a problem before. I felt rotten and did for awhile.

What I did to settle this all down was nothing. And it worked, by that I mean I didn't decrease or taper for a month or 6 weeks and once I got my dosage schedule squared away I also did nothing but keep it the same. I avoided extra stimulating activity as it too left me exhausted. Maybe try more gentle activities that you enjoy for awhile? Just a thought.

So I kept everything the SAME for months and eventually all systems settled down and the last 2 weeks or more were back to normal. THEN I dropped my dose of AD a TINY bit... felt some WD and waited 5 weeks to drop again and THAT drop has gone amazingly well.... I have had very few WD symptoms and the drop was actually a little larger than the first and I've slowly been able to do more and more activating activities that before were very difficult.

I'm beginning to believe that the most important piece of the puzzle in being successful is being very, very patient. Just wait rettsgirl. Don't change anything with your dosages now, the time that you take them etc. Things will settle down but it takes time.

So yes, others have experienced what you describe. You have "upset" your nervous system and it needs time to readjust and then more time to get used to the new adjustment and then you can continue tapering. Just don't let the WD symptoms take control of you and your thinking. You are in control, things will get better, nothing terrible is going to happen to you. Just wait. You'll see!!!!

RU

February 11, 2013

Excellent advice, RU.

Rhettsgirl, did the 75mg feel okay for a few days, and then this overexcited feeling started?

February 12, 2013

I honestly haven't felt great since the 2 weeks after I switched to 75mg. I did briefly (3 days) switch back to 80mg but then went back down to 75mg and I'm staying there. My take on this whole thing is that the initial dosage change activated my CNS. Now, though, I'm noticing that sensitization and I'm letting my original anxiety disorder breathe even more life into this.

I believe I've scared myself and I can't tell what anxiety is coming from me worrying and what's coming from my body. It sucks! I'm so angry with myself for letting myself get upset and I am trying to tell myself to stop worrying, wondering, ruminating. But, that's the whole thing behind an anxiety disorder and it's why I didn't start tapering in the first place. I was afraid of awakening those anxious feelings I thought I would have a handle on if they should show up. Now, I'm finding it hard to separate myself from the feelings and the thoughts that amplify the scary feelings. I think you'd have to have an anxiety disorder to understand it.

Anyway - here I am. Stuck in the middle of my anxiety disorder caused by the stimulation of decreasing my antidepressant. I feel stuck. How do I stay calm long enough to let my body calm down? It's a vicious cycle.

I feel crazy, though I know I'm not the first person to ever feel this way nor will I be the last.

Anyone else with an anxiety disorder on here?

Any advice? My doctor just tells me not to think about it.

February 12, 2013

Please keep daily notes of your dosage, when you take it, and your symptom pattern.

July 7, 2013

Just an update. I am on the 75mg dose now and stable. I think it took me until about April to finally feel pretty good again. I still have little 'bouts of anxiety where my body feels overexcited, but I'm able to function all right. I didn't come back here because I didn't want tapering to be my life and my focus. I think Silverstar gave me the most applicable advice to my situation. Thank you to you all!

I'm not sure if I'm brave enough to try to continue tapering - even 1 mg at a time! I do think if I did taper and waited very, very patiently, I could get off this stuff for good. I haven't made up my mind to be brave enough to suffer again. I do thank you for your advice and your support! I couldn't have made it those first few weeks without you.

I will most likely be back - when I get brave enough to pick up and continue the taper.

July 8, 2013

Rhettsgirl, do what you need to do. You'll be welcome back here any time.

And as you can see, you DID stabilize. So it appears that you can adapt to drops, but you will need to make them very small.

When you are ready to taper (if you are, but I think you're going to be) I would consider starting with 0.5 mg (half a milligram) drops at first. At first, wait a long time in between drops, three weeks or so, just to observe your withdrawal symptoms, how they come on and how they decline. Keep a journal, daily, ranking your symptoms on a scale of 1 to 5 or something like that, and noting your dosage, what time you took it and how much. The journal is your way of gathering information for yourself to look back on later and see what patterns your withdrawal follows.

If you take the first three to six months of your taper really slowly and make that your "information gathering" time, you can then speed up, if that seems appropriate, slowly and carefully, until you find out what your limits are.

Doing it this way will give you a great degree of control over your taper and over your withdrawal symptoms and recovery. Since you're making such small cuts, you're not likely to cut too much at once. Since you're taking long holds between cuts, you're not likely to get ahead of the lag time and cut too much before the full withdrawal kicks in. And as you get more accustomed to your body's patterns of withdrawal, you'll have so much more power and choice in how the withdrawal plays out in your life. I think this has been really key for me, to making the whole process much less scary. It's not really scary for me at all any more, although it's still tedious and annoying!

But I certainly don't blame you for wanting to enjoy feeling well right now, after what you've been through.

July 20, 2013

Rhi - Thank you so much! You certainly do understand! I wish you well on your journey. I'm sure I'll be joining you again soon. I love your idea of journaling.

And - I appreciate you not making me feel bad for not going back to tapering right away.

July 24, 2013

Rhi - Thank you so much! You certainly do understand! I wish you well on your journey. I'm sure I'll be joining you again soon. I love your idea of journaling.

And - I appreciate you not making me feel bad for not going back to tapering right away.

:-)

Enjoy your summer, do what you need to do. We're here when and if you need us.

February 18, 2018

Hi Rhettsgirl, how are you doing these days?

January 1, 2019

On 2/18/2018 at 12:25 AM, ChessieCat said:

Hi Rhettsgirl, how are you doing these days?

Thank you for asking. Still here but knowing that I must decrease my medication eventually. Talked with my doctor about it a few days ago and he suggested taking a pin to let tiny amounts of the capsule powder out so that I have control over my taper.

My daughter is a Junior in high school and since I feel fine on 75 mg, I do think that I’ll stay here until she is off to colllege. I can’t have her watch me go through that withdrawal. It’s so hard to act normal when I’m decreasing and I want to enjoy the last 1 1/2 years of enjoying my life while she still lives as home.

I am a coward and so afraid to try again.

January 1, 2019

Hi rhettsgirl, thanks for coming back and updating.

54 minutes ago, rhettsgirl said:

Talked with my doctor about it a few days ago and he suggested taking a pin to let tiny amounts of the capsule powder out so that I have control over my taper.

It's good that your doctor is on board with you tapering carefully. However unless you weigh the powder his suggestion may not be very accurate. I've provided more information below which would be a better option.

tips-for-tapering-off-nortriptyline

According to information in Post #1 (right at the bottom of the post) of the tips topic you can make your own liquid.

Make a nortriptyline liquid yourself from tablets or capsules

Nortriptyline is soluble in water. See How to make a liquid from tablets or capsules

Use an oral syringe to precisely measure out doses as small as .01mg.

If you are currently taking 75mg you could get 50mg and make up to the needed taper dose using DIY or prescription liquid. The brain likes consistency and the more accurate and consistent you can get your dose the better.

It is supplied in 10mg, 25 mg, 50 mg, 75 mg capsules (Teva) and an oral solution (10 mg/5 mL) http://www.drugs.com/pro/nortriptyline-oral-solution.html .

Here are some helpful links:

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's Withdrawal Symptoms

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

What should I expect from my doctor about withdrawal symptoms?

How do you talk to a doctor about tapering and withdrawal?

Video: Healing From Antidepressants - Patterns of Recovery

You could always start tapering now but reduce by less than 10%:

Brass Monkey Slide

Micro-taper instead of 10% or 5% decreases

Rhi's "Start Small, Listen to Your Body" Taper Plan

July 8, 2020

Titled: Nortriptyline by Gradually Switching to Amitriptyline?

In 6 months my doctor and I are planning to start tapering off of the 75 mg of Nortriptyline that I've been on for 17 years. I did once years ago reduce from 80 mg to 75 mg and it was a horrible experience for me. I would be at work and the panic feelings were so strong I'd feel like I wanted to scream in terror, but I just kept my head down and tried to work.

Anyway, my doctor was suggesting that perhaps I could slowly wean down on the Nortriptyline and switch over to Amitriptyline and then wean from there. I'm a very anxious person and sometimes have trouble sleeping so he thought perhaps the Amitriptyline could help with my anxiety and be easier to withdraw from than Nortriptyline.

I'd like to hear some thoughts on this. I don't want to add another drug to the mixture, but if there's a chance that I could reduce without the horror feelings, that would certainly be wonderful. But, I always think that you end up paying the piper one way or another, so maybe I just grit my teeth and reduce the Nortriptyline - the drug that I know.

Anyone want to weigh in on this? I'd be grateful for a few thoughts.

Edited July 8, 2020 by manymoretodays
Added title to post, tag, moved from tapering

July 8, 2020

Hello, rhettsgirl. It's been a long time since we've heard from you.

What other drugs are you taking now? 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.

Nortriptyline has a fairly short half-life of about a day, compared to amitriptyline, its parent drug.

July 9, 2020

Here is the list of drugs that I am currently taking - linked to the Drug interaction report.

Nortriptyline 75 mg (Taken once per day)

Chlordiazepoxide 10 mg (1 per day)

Levothyroxine 100 mcg

https://www.drugs.com/interactions-check.php?drug_list=1734-0,585-0,1463-3517

July 9, 2020

What times of day do you take each of your drugs?

When you reduced nortriptyline before, is it possible you forgot to take chlordiazepoxide or changed the times you take it?

Are you feeling any adverse effects from your drugs now? What times of day do they occur?

July 10, 2020

When I reduced my dosage in 2013 from 80mg to 75 mg, I took both my nortriptyline and chlordiazepoxide at the same time just before bedtime. I never missed a dose of the chlordiazepoxide. I wish it would have been something so easy to fix. I currently take the nortriptyline with my evening meal (6ish) because I started getting night time reflux when I took it at bedtime. I still take the chlordiazepoxide at bedtime and I take my levothyroxine in the morning before I eat anything. No adverse effects from the medications at this time - except for the reflux which corrected itself when taken with food. I feel fine and wish that I wouldn't have to go through the tapering process. But, at 53, I think it's time for me to get off of the medication before advanced age makes the medicine harder to take. I'm also worried about my brain health, but I fear the damage is already done. I try not to worry about that too much. I can't turn back time.

Thank you for weighing in and trying to troubleshoot. I appreciate any ideas. Not looking forward to the taper.

June 15, 2021

Hi! I'm back! Finally!

The time has come to really get off of the Nortriptyline I have been on since 2004. I'm currently on 75 mg and am planning to start my taper as soon as my daughter goes back to college (Early September). I'd like to see if I can go from 75 mg to 60 mg by the end of the year.

Is that too ambitious do you think? I know every one is different.

June 15, 2021

Welcome back, @rhettsgirl

Here's your Intro topic. How have you been feeling on 75mg nortriptyline? Are you still taking the other drugs? What is your daily drug schedule?

See Tips for tapering off nortriptyline

June 15, 2021

I have been feeling great on the 75 mg of nortriptyline. I take the entire 75 mg nortriptyline around 6 pm with supper. (I get heartburn if I don't have it with something to eat) and I take the 10 mg of chlordiazepoxide at night before bed time. I am off of the Ambien.

The only other medication I take is levothyroxine 100 mcg, but I didn't think it was relevant. If it is, I'll add it to my signature.

I am probably the happiest I've been in years, I hate to ruin it by weaning off of my medication, but I'm 54 and feel I should get off before my body has trouble metabolizing the medications.

June 19, 2021

Would anyone like to respond to my question? I was excited to see Altostrata's initial response but no chime in. I would really welcome some feedback to my questions. TIA

June 19, 2021

Reducing from 75mg to 60mg in four months is quite doable. Our recommended starting taper is 10% every four weeks and your proposed schedule would be slower than that, which can be a good thing. I would suggest your take a look at the Brassmonkey Slide. It would involve four reduction of 2.5% spaced over four weeks and then an additional two week hold. We are having very good success with it. It is designed to limit the symptoms one feels with each reduction. You will find more information here:

https://www.survivingantidepressants.org/topic/17671-the-brassmonkey-slide-method-of-micro-tapering/

June 19, 2021

Thank you! That makes me feel a lot better. It’s something I want to do for my health. I’ll start when my daughter goes back to college in the fall and by the time I have my next psych Appt in December, I hope to tell him that I’m down to 60 mg.

I’ll take a look at the micro tapering and go that route.

Thank you so much for your feedback. I feel encouraged. Have a great evening!!

Rhettsgirl: small decrease causing havoc?

Recommended Posts

rhettsgirl

Link to comment

xDebbiejo

Link to comment

rhettsgirl

Link to comment

Karma

Link to comment

Jemima

Link to comment

rhettsgirl

Link to comment

Altostrata

Link to comment

rhettsgirl

Link to comment

Wingbatty

Link to comment

lindamorellato

Link to comment

Jemima

Link to comment

rhettsgirl

Link to comment

Altostrata

Link to comment

rhettsgirl

Link to comment

areyouthere

Link to comment

Altostrata

Link to comment

rhettsgirl

Link to comment

Altostrata

Link to comment

rhettsgirl

Link to comment

Rhiannon

Link to comment

rhettsgirl

Link to comment

Rhiannon

Link to comment

ChessieCat

Link to comment

rhettsgirl

Link to comment

ChessieCat

Link to comment

rhettsgirl

Link to comment

Altostrata

Link to comment

rhettsgirl

Link to comment

Altostrata

Link to comment

rhettsgirl

Link to comment

rhettsgirl

Link to comment

Altostrata

Link to comment

rhettsgirl

Link to comment

rhettsgirl

Link to comment

brassmonkey

Link to comment

rhettsgirl

Link to comment

Create an account or sign in to comment

Create an account

Sign in

Browse

Activity

Important Information