Serenity23: Neurological symptoms - medical, stress, or SSRI withdrawal?

[apace41]

This is a good site.

 

http://thyroidpharmacist.com/

 

Andy

[Persephone]

Hi everyone, I'm still on 25mg Sertraline. I'm going through some personal things and it's just not the right time to be tapering off this medication. I did have a question. My doctor gave me Rizatriptan for these new migraines I've been experiencing, and I read something about Serotonin Syndrome occurring if you take a medication like Rizatriptan and you don't wait 6 hours before taking an SSRI. I was not aware of this. Does anyone know if this is true?

 

Hi Serenity,

 

I tried rizatriptan a few times. I asked my pharmacist about serotonin syndrome, and she said that if I only take it occasionally, it shouldn't be a problem. BUT... she had to go look it up first. Initially she wasn't aware of possible interactions with SSRIs and neither was my doctor, so I don't have any particular confidence in their advice.

 

I also was given another triptan to try, zolmitriptan. The triptans don't help my migraines, and I am actually relieved they don't, because the whole time I was worried about taking them with an SSRI.

 

The other thing that you should be aware of with triptans, is that if you take them too frequently they will cause rebound headaches.

 

My doctors now are suggesting preventive medication: amitriptyline or topomax - which are both medications that people on this forum are trying to taper of off. Consequently, I have been trying to treat my migraines with a multitude of lifestyle changes. 

 

I hope you get relief from the migraines, and that things calm down for you with the personal issues. Take care of yourself!

[Serenity23]

Serenity,

 

You just need to have them run the test for thyroid antibodies. That will pick up any chance of Hashimoto's.

 

Best,

 

Andy

Thank you Andy. What type of doctor will test for thyroid antibodies?

[Serenity23]

This is a good site.

 

http://thyroidpharmacist.com/

 

Andy

Thanks Andy. I agree, it is. Unfortunately it seems that hypothyroidism is a female disease and I figured it'd take a female in the medical profession to put something together like this.

[apace41]

 

Thank you Andy. What type of doctor will test for thyroid antibodies?

 

Find  a doc in the NJ area near you that specializes in functional medicine. They will run the right tests for Hashimoto's and other thyroid issues.  Fresh listed the full panel that you can get but you need a group that doesn't just look at the "reference range" because those things are based on the general population which is, by and large, quite sick.

[Serenity23]

 

Hi everyone, I'm still on 25mg Sertraline. I'm going through some personal things and it's just not the right time to be tapering off this medication. I did have a question. My doctor gave me Rizatriptan for these new migraines I've been experiencing, and I read something about Serotonin Syndrome occurring if you take a medication like Rizatriptan and you don't wait 6 hours before taking an SSRI. I was not aware of this. Does anyone know if this is true?

 

Hi Serenity,

 

I tried rizatriptan a few times. I asked my pharmacist about serotonin syndrome, and she said that if I only take it occasionally, it shouldn't be a problem. BUT... she had to go look it up first. Initially she wasn't aware of possible interactions with SSRIs and neither was my doctor, so I don't have any particular confidence in their advice.

 

I also was given another triptan to try, zolmitriptan. The triptans don't help my migraines, and I am actually relieved they don't, because the whole time I was worried about taking them with an SSRI.

 

The other thing that you should be aware of with triptans, is that if you take them too frequently they will cause rebound headaches.

 

My doctors now are suggesting preventive medication: amitriptyline or topomax - which are both medications that people on this forum are trying to taper of off. Consequently, I have been trying to treat my migraines with a multitude of lifestyle changes. 

 

I hope you get relief from the migraines, and that things calm down for you with the personal issues. Take care of yourself!

 

Thanks, Persephone. What lifestyle changes do you find help?

 

I do find that I get migraines when I am tired; stressed; dehydrated; hungry. Ever since my July hospitalization, my hunger and thirst mechanism has been way off. Just last night I had a corn muffin at a local diner and got a migraine while driving afterward. I assumed it must have had a high amount of sodium so I had to find a dunkin donuts to get some water. I chugged 20oz and I still didn't feel well. I've never experienced this before in my life. I wish there was a specialist I could see about whatever is going on with my brain and/or thyroid but I have no idea who to go see. My regular doctor does still want to check my serum sodium levels every 6 months, though.

 

My local pharmacist told me about a homeopathic nose spray that is supposed to help migraines. I bought it but am afraid to try it since it's main active ingredient is capsaicin and I'm just not sure I am prepared to spray hot red pepper up my nose. For now I just suffer with the migraines or occasionally take an Excedrin Migraine if it's absolutely unbearable. What do you do?

[Serenity23]

 

 

Thank you Andy. What type of doctor will test for thyroid antibodies?

 

Find  a doc in the NJ area near you that specializes in functional medicine. They will run the right tests for Hashimoto's and other thyroid issues.  Fresh listed the full panel that you can get but you need a group that doesn't just look at the "reference range" because those things are based on the general population which is, by and large, quite sick.

 

Thanks Andy. I really appreciate this. I hope your taper is going well. :-)

 

A couple of years ago I had gone to see a holistic nurse practitioner. She was good but when she told me the blood work she ordered for me would take 9 vials of blood....I wimped out. I was fearful of passing out. It's time to take some action now, as living this way is not living. Not to mention spring/summer is approaching and I am afraid of getting dehydrated again. My husband thinks since I've spent all this time since July making sure not to overdue the water intake (I was told no more than ~6 glasses a day), that I actually haven't been drinking enough. I may go back to tracking it, although my fear was that I'd get too OCD with it.

 

I still think the medication is causing this, even though there's only research that it effects the elderly. I've been on SSRI's for 20 years. Maybe this is just a long term side effect.

 

That being said, it could still be my thryoid. I had been following a very strict plant based "clean" diet for the last couple of years, and I hadn't had any iodine in my diet. I thought my multivitamin had it, but it did not. Plus I was eating about 4-5 oz of kale on most days, in addition to other cruciferous vegetables which could affect the thyroid. I've since gone back to eating more "balanced" per the hospital's medical staff and my doctor's suggestion.

 

But I don't think this issue with migraines, and my hunger/thirst mechanism being completely non-existent, as well as my extreme sensitivity to hunger and thirst, is related to my thyroid, do you?

[AliG]

Serenity.   Have you looked into your diet ?   Wheat / gluten , dairy etc ?   If not , you could possibly start looking at some of the causes, apart from the drugs.

Ali.

[Serenity23]

Serenity.   Have you looked into your diet ?   Wheat / gluten , dairy etc ?   If not , you could possibly start looking at some of the causes, apart from the drugs.

Ali.

Thanks for the reply, Ali. I don't eat much wheat/gluten or dairy. That being said, I do want to take a food allergy test.

[Fresh]

Hot tip: kale is very bad for people with sluggish thyroids.

 

Any gp can order bloods to get thyroid levels. You don't need to wait to find a new functional medicine

doctor.

[apace41]

Any gp can order bloods to get thyroid levels. You don't need to wait to find a new functional medicine

doctor.

 

They can but in the US many won't. The thyroid antibody test is not part of the standard thyroid package and you can certainly ask but a lot of conventional GPs won't simply order it.

[Serenity23]

Hot tip: kale is very bad for people with sluggish thyroids.

 

Any gp can order bloods to get thyroid levels. You don't need to wait to find a new functional medicine

doctor.

Yes kale, broccoli, cauliflower, cabbage, Brussels sprout, collard greens...cruciferous vegetables.... all those vegetables I was eating to prevent cancer and stay healthy. (I used to make daily green smoothies with 4oz of kale). I'm more careful with my amounts now.

 

What Andy says is correct. US MD's do not generally test for anything other than T3, T4, and TSH. Perhaps if I can find a truly scientifically researched paper online about running thyroid antibodies, my MD will agree to do so. If not, I will look for a functional medical doctor.

 

In good news, I haven't needed Xanax since August. I even had a very frightening situation on the expressway a few months ago that could've caused a bad panic attack but didn't. I was able to be relatively calm in the moment.  An SUV went completely out of control because he hit his brakes too hard at a merge. All of us cars just stopped as he tried to get control of his car. I was able to watch as it was happening without panicking. He was doing 360's from one end of the lanes to the other in back of us, in front of us, to the side of us, etc. It was amazing he didn't hit the guard rail or any of us and he was okay. I pulled over a few minutes later when I could and just took a few deep breaths. That being said, I was curious if it is illegal for me to carry one Xanax in my purse in case of panic attack, or must I carry the entire bottle with me with the label?

[Persephone]

Thanks, Persephone. What lifestyle changes do you find help?

 

I do find that I get migraines when I am tired; stressed; dehydrated; hungry. Ever since my July hospitalization, my hunger and thirst mechanism has been way off. Just last night I had a corn muffin at a local diner and got a migraine while driving afterward. I assumed it must have had a high amount of sodium so I had to find a dunkin donuts to get some water. I chugged 20oz and I still didn't feel well. I've never experienced this before in my life. I wish there was a specialist I could see about whatever is going on with my brain and/or thyroid but I have no idea who to go see. My regular doctor does still want to check my serum sodium levels every 6 months, though.

 

My local pharmacist told me about a homeopathic nose spray that is supposed to help migraines. I bought it but am afraid to try it since it's main active ingredient is capsaicin and I'm just not sure I am prepared to spray hot red pepper up my nose. For now I just suffer with the migraines or occasionally take an Excedrin Migraine if it's absolutely unbearable. What do you do?

 

 

Maybe the nose spray is supposed to work by distracting you from the migraine pain with intense nasal pain!

 

I have been trying a lot of things to help the migraines, so I am not sure exactly what is helping - it could be a combination. Fortunately, there's been a big improvement in the severity of my migraines, although I still get them almost daily. Here is what I am doing:

1. Maintaining a regular schedule for eating, drinking and sleeping. Like a baby.
2. Diet: I had already been avoiding most of the obvious food triggers (for another health reason) when my migraines got worse: caffeine, chocolate, dairy, alcohol, and citrus. So I went a step further and now I am on a migraine elimination diet. There are several different ones, and many of them are polar opposites. The one that I am trying for now is by Dr. David Buchholz. There is a summary here: Top Ten Migraine Triggers. Another popular one, that is more paleo style, is by Dr. Josh Turknett. They are both neurologists, but the diets are quite different. It can take a couple of months for dietary changes to help. Also, different people have different food triggers. Some people find that gluten and refined carbohydrates are triggers. For myself, I avoid refined carbohydrates and have a bit of protein with every meal or snack. 
3. **Sleep hygiene: I think this is what has been helping me the most. Apparently, I had dusty, grimy sleep habits! I love light and I had been sleeping without curtains. I also used to keep bright lights on right until bedtime, sometimes even sleeping with a light on. Now I am sleeping in total darkness, dimming the lights in the evening, and not going on the computer or using devices after supper. I also make sure that I get a good, long dose of daylight in the morning. These things all help increase the level of melatonin your body makes in the evening, so that you sleep better. It took about 2 weeks to feel the improvement. My migraines are much less intense and my energy has increased.
4. Meditation, mindfulness and avoiding stress. :-)
5. Gentle exercise every day. (Intense exercise can actually bring on a migraine.)
6. Avoiding painkillers. Unfortunately, taking headache meds too often, including over-the-counter ones, can lead to rebound headaches. (I don't think there is a problem if you only take painkillers occasionally, like you are doing.) I have been having migraines almost daily, so I try to sleep off the migraine in a dark, quiet room, with an icepack on my head. I found a great icepack especially for headaches that you wear like a headband. I look like a 70's rockstar, especially with my bedhead. 
7. Supplements: Magnesium, B2, Feverfew, Butterbur, and Coenzyme Q10. I have no idea if they are helping, but these are the ones that are suggested frequently for migraines. Again, it can take a couple of months. I have been on the diet and the supplements for 7 weeks now. Who knows, maybe the migraines will disappear with a poof! in another week or two.

[Serenity23]

UPDATE: My doctor just diagnosed me with Orthostatic Hypotension. He wants me to get another MRI at the same hospital I was at in Jan/Feb '15 with the stroke like symptoms. I'll be having blood work too and he did mention the possibility of going to an Endocrinologist.

 

I want to thank everyone who has been keeping up with my posts.

 

Some day my health will be back in equilibrium where I can do a slow taper of the Zoloft. It's just taking longer than I hoped.

[Serenity23]

 

Thanks, Persephone. What lifestyle changes do you find help?

 

I do find that I get migraines when I am tired; stressed; dehydrated; hungry. Ever since my July hospitalization, my hunger and thirst mechanism has been way off. Just last night I had a corn muffin at a local diner and got a migraine while driving afterward. I assumed it must have had a high amount of sodium so I had to find a dunkin donuts to get some water. I chugged 20oz and I still didn't feel well. I've never experienced this before in my life. I wish there was a specialist I could see about whatever is going on with my brain and/or thyroid but I have no idea who to go see. My regular doctor does still want to check my serum sodium levels every 6 months, though.

 

My local pharmacist told me about a homeopathic nose spray that is supposed to help migraines. I bought it but am afraid to try it since it's main active ingredient is capsaicin and I'm just not sure I am prepared to spray hot red pepper up my nose. For now I just suffer with the migraines or occasionally take an Excedrin Migraine if it's absolutely unbearable. What do you do?

 

 

Maybe the nose spray is supposed to work by distracting you from the migraine pain with intense nasal pain!

 

I have been trying a lot of things to help the migraines, so I am not sure exactly what is helping - it could be a combination. Fortunately, there's been a big improvement in the severity of my migraines, although I still get them almost daily. Here is what I am doing:

1. Maintaining a regular schedule for eating, drinking and sleeping. Like a baby.
2. Diet: I had already been avoiding most of the obvious food triggers (for another health reason) when my migraines got worse: caffeine, chocolate, dairy, alcohol, and citrus. So I went a step further and now I am on a migraine elimination diet. There are several different ones, and many of them are polar opposites. The one that I am trying for now is by Dr. David Buchholz. There is a summary here: Top Ten Migraine Triggers. Another popular one, that is more paleo style, is by Dr. Josh Turknett. They are both neurologists, but the diets are quite different. It can take a couple of months for dietary changes to help. Also, different people have different food triggers. Some people find that gluten and refined carbohydrates are triggers. For myself, I avoid refined carbohydrates and have a bit of protein with every meal or snack. 
3. **Sleep hygiene: I think this is what has been helping me the most. Apparently, I had dusty, grimy sleep habits! I love light and I had been sleeping without curtains. I also used to keep bright lights on right until bedtime, sometimes even sleeping with a light on. Now I am sleeping in total darkness, dimming the lights in the evening, and not going on the computer or using devices after supper. I also make sure that I get a good, long dose of daylight in the morning. These things all help increase the level of melatonin your body makes in the evening, so that you sleep better. It took about 2 weeks to feel the improvement. My migraines are much less intense and my energy has increased.
4. Meditation, mindfulness and avoiding stress. :-)
5. Gentle exercise every day. (Intense exercise can actually bring on a migraine.)
6. Avoiding painkillers. Unfortunately, taking headache meds too often, including over-the-counter ones, can lead to rebound headaches. (I don't think there is a problem if you only take painkillers occasionally, like you are doing.) I have been having migraines almost daily, so I try to sleep off the migraine in a dark, quiet room, with an icepack on my head. I found a great icepack especially for headaches that you wear like a headband. I look like a 70's rockstar, especially with my bedhead. 
7. Supplements: Magnesium, B2, Feverfew, Butterbur, and Coenzyme Q10. I have no idea if they are helping, but these are the ones that are suggested frequently for migraines. Again, it can take a couple of months. I have been on the diet and the supplements for 7 weeks now. Who knows, maybe the migraines will disappear with a poof! in another week or two.

 

Persephone, I just saw this now. My apologies. Thank you for taking the time to list (I love lists; I retain info better that way) things you did. My therapist brought up a good point, "How do you know these are migraines? Have you had an MRI?" The symptoms are definitely migraine like, but now with other medical stuff going on, I'm glad I will be getting an MRI to know for sure. Is that how yours were diagnosed?

 

Coincidentally, I am already trying to do a lot of the things you posted. I didn't know they were migraine related actually, but it was something I noticed helped. Fortunately I did read about the rebound headaches, as I dislike taking meds in the first place unless warranted, so I've been keeping the prescription med in my purse for emergencies while driving and I've only taken Excedrin Migraine when absolutely necessary. I've been very scheduled with eating, sleeping, and drinking lately but now my doctor wants me to be stricter with tracking my fluid intake. (I agree--I was just trying not to get OCD about stuff). If my husband wants dinner late, I make a protein smoothie to tie me over. I've been eating more protein than I had been. I can't help but wonder if the strict plant based diet I was following for a few years messed up my electrolytes or my hypothalamus somehow. I would've thought my body would've bounced back to eating more salt and drinking more fluids by now but it hasn't.

 

I don't seem to have food triggers although I feel worse when I eat a high-salt meal. I was afraid to exercise because of losing sodium in sweat, but I should at least do gentle walking. Meditation, mindfulness--trying to get more disciplined with these things but I'm not. Avoiding stress--trying to do this as well (been coloring a lot and watching non-triggering food network). I really like the point about sleep hygiene. My husband likes to read his tablet in bed, and then he falls asleep while reading. I know the blue light is bad for sleep. Sometimes I read on my cell phone while in bed and that's not good, either.

 

Changing the subject for a moment, I read online that antidepressants like zoloft could cause Orthostatic Hypotension. In thinking back, I do recall it was in the 1990s (when I first started on SSRIs) that I'd get positional vertigo for a second or two when I'd bend down to pick up something off of the bottom shelf at the supermarket. I never really thought about it much. Sometimes I just wish someone would say, "I went through the same exact symptoms, this is what caused it, and this is what fixed it."

[Serenity23]

 

Any gp can order bloods to get thyroid levels. You don't need to wait to find a new functional medicine

doctor.

 

They can but in the US many won't. The thyroid antibody test is not part of the standard thyroid package and you can certainly ask but a lot of conventional GPs won't simply order it.

 

Andy I asked my GP if he could test the thyroid antibodies and he said he doesn't order them if the TSH, T3 and T4 tests are normal. I'm curious if those are. I just got those tested.

[apace41]

Andy I asked my GP if he could test the thyroid antibodies and he said he doesn't order them if the TSH, T3 and T4 tests are normal. I'm curious if those are. I just got those tested.

 

 

 

If what are normal, Serenity.  Not following.  Do you have test results?

 

[Serenity23]

 

Andy I asked my GP if he could test the thyroid antibodies and he said he doesn't order them if the TSH, T3 and T4 tests are normal. I'm curious if those are. I just got those tested.

 

 

 

If what are normal, Serenity.  Not following.  Do you have test results?

 

 

Sorry Andy for not writing more clearly, I am extremely fatigued at the moment. I got blood work yesterday morning, which I believe included TSH, T3 and T4. He wasn't willing to run the thyroid antibodies if those come out normal. I should have test results shortly.

[apace41]

Sorry Andy for not writing more clearly, I am extremely fatigued at the moment. I got blood work yesterday morning, which I believe included TSH, T3 and T4. He wasn't willing to run the thyroid antibodies if those come out normal. I should have test results shortly

 

No need to apologize, Serenity.  I see what you were saying now.  Yes, keep us posted.  There are several things to look at here.  If the tests all come back "normal" we need to see what "normal" means.  Tests all come with a "reference range" and these are based on the population generally.  That means they are being established on the basis of a very "sick" population.  So, if you are at the edges of the "normal" range you might still want to get antibody testing.  You might have to pay for it out of pocket but you can get it directly online if it comes to that point.

 

Best,

 

Andy

[Persephone]

Persephone, I just saw this now. My apologies. Thank you for taking the time to list (I love lists; I retain info better that way) things you did. My therapist brought up a good point, "How do you know these are migraines? Have you had an MRI?" The symptoms are definitely migraine like, but now with other medical stuff going on, I'm glad I will be getting an MRI to know for sure. Is that how yours were diagnosed?

 

Coincidentally, I am already trying to do a lot of the things you posted. I didn't know they were migraine related actually, but it was something I noticed helped. Fortunately I did read about the rebound headaches, as I dislike taking meds in the first place unless warranted, so I've been keeping the prescription med in my purse for emergencies while driving and I've only taken Excedrin Migraine when absolutely necessary. I've been very scheduled with eating, sleeping, and drinking lately but now my doctor wants me to be stricter with tracking my fluid intake. (I agree--I was just trying not to get OCD about stuff). If my husband wants dinner late, I make a protein smoothie to tie me over. I've been eating more protein than I had been. I can't help but wonder if the strict plant based diet I was following for a few years messed up my electrolytes or my hypothalamus somehow. I would've thought my body would've bounced back to eating more salt and drinking more fluids by now but it hasn't.

 

I don't seem to have food triggers although I feel worse when I eat a high-salt meal. I was afraid to exercise because of losing sodium in sweat, but I should at least do gentle walking. Meditation, mindfulness--trying to get more disciplined with these things but I'm not. Avoiding stress--trying to do this as well (been coloring a lot and watching non-triggering food network). I really like the point about sleep hygiene. My husband likes to read his tablet in bed, and then he falls asleep while reading. I know the blue light is bad for sleep. Sometimes I read on my cell phone while in bed and that's not good, either.

 

Changing the subject for a moment, I read online that antidepressants like zoloft could cause Orthostatic Hypotension. In thinking back, I do recall it was in the 1990s (when I first started on SSRIs) that I'd get positional vertigo for a second or two when I'd bend down to pick up something off of the bottom shelf at the supermarket. I never really thought about it much. Sometimes I just wish someone would say, "I went through the same exact symptoms, this is what caused it, and this is what fixed it."

 

Hi Serenity,

 

Unfortunately, migraines cannot be diagnosed with an MRI. The MRI is used to rule out other causes of the headaches. See this link for more info: http://www.webmd.com/migraines-headaches/making-diagnosis-mri. I had an MRI because my doctor was concerned about the dramatic change in the frequency of my migraines. My MRI results were normal, as are the results of most people with migraines, so don't get worried that they are checking for scary sounding stuff. It is just to rule it out and move on.

 

Migraines can only be diagnosed by evaluating the symptoms. This site has clear information on how migraines are diagnosed: http://www.headaches.org/2007/10/25/migraine/ The white circle lights that you described previously sounded to me a lot like a migraine aura.

 

I am not surprised that you are already doing a lot of the things I mentioned before - it is all about being healthy and taking care of yourself, which you are obviously working hard at. I have not been able to find any food triggers for myself, either, but after you mentioned sodium a while back, I've been more aware, and careful, of the salt in my food. That was a good tip! My migraines did not poof away yet, but there is definitely a g r a d u a l  r e d u c t i o n happening. In the last two weeks I have only had two migraines, and they were preceded by: eating homemade popcorn that was too salty, and two large pieces of toasted, white nan bread sprinkled liberally with cinnamon sugar. Bad food choices were made on those days! I am going to clean out any unwise temptations from my kitchen.

 

I am sorry to say that none of the doctors I have consulted about migraine have been helpful. They just keep offering different medications to take, and when I look up the medications on the checker site, they always conflict with the antidepressants. Also - IMPORTANT - no one know yet how migraines are caused, and they also don't know why certain medications seem to help. This story may sound familiar to you, if you have read The Anatomy of an Epidemic. The migraine preventative medications have all been found by accident, and they seem to work by changing something in the brain. I have had to take my recovery into my own hands by doing a ton of research and by using common sense. I am no longer willing to try anything the doctors prescribe for migraine (although I try to be gentle and concise when educating them about why it is unwise to prescribe certain medications - "I am not comfortable taking medicine X because it is sedating and I am already on medicine Y which is also sedating").

 

I like the colouring idea. My daughter have me a beautiful flower colouring book awhile ago that I should restart.

[Serenity23]

Hi everyone, here's an update. I hope everyone is doing well.

 

My insurance turned down the MRI but as someone posted here, an MRI wouldn't diagnose migraines. I'm not sure what to do. My doctor said to keep a headache diary. The headaches now are different than the debilitating migraines. They're like a lesser form of them and I can distract myself from them although they're still there. Sometimes I stop thinking about this stuff entirely, because I don't want to think too much about it which might make it all worse. So I haven't been thinking about it.

 

My chlorine blood levels were abnormally low, but the nurse who called with my results said "everything's normal". She mumbled it when she said it, like she wasn't confident in what she said. However, I checked my labs online and saw the chlorine was low. She's a nice woman and I'm sure she's a competent nurse even though I've only dealt with her on the phone. I'm sure it's strange dealing with anomaly like electrolyte imbalances when you're a family doctor's nurse who probably sees high blood sugar and high cholesterol day in and day out or routine minor health issues. Normally I know mildly abnormally low electrolytes aren't an issue, but I'd say it is, given that there's obviously something wrong with my electrolyte balance, which could be harmful.

 

A health care friend of mine who I happened to ask what she thought about the low chlorine and the orthostatic hypotension. She said it sounds like POTS, which is ironic. I have a friend who was diagnosed with dysautonomia about 20 years ago and she joked last summer that I might have that.

 

I haven't pushed this too much with my current doctor, or gone just yet to see a functional doctor because I would be mortified if this was all a physiological reaction to stress. I've been going through a lot of personal growth the last few years and it's taken a toll. I'm just not sure what is medical, and what is due to that. 

 

Is it an Endocrinologist who would diagnose POTS or Dyautonomia, or would a functional doctor diagnose that? What type of doctor would do the "tilt test" and other types of tests?

 

I am still getting odd headaches every day but they are hard to explain. It feels like my brain/head is "clogged" or "blocked". My processing abilities and memory have been off for quite a while. I also can't find words that I want to use. I haven't brought this up with my doctor because of the fear he'll just say "anxiety". I've been a lot less anxious than I used to be so I'm not sure what this is.

 

My body temperature still seems very off. My feet still get so cold that it's painful. I'm told my hands are ice cold. I wake up in the middle of the night because I'm either too hot or too cold but it's not an anxiety way of waking up. I can tell this is not anxiety-induced. My anxiety has greatly improved. Weekly yoga has just been the icing on the cake with that.

 

I'm getting weird cramps in my heart--nothing painful but I notice them--but who knows, that could just be acid reflux or something. It also could be due to my being very out of shape currently and I just have to get used to that. It's really hard to know when something is "nothing" or something is an issue to mention to a doctor.

 

Lastly, no matter how much sleep I get, I never wake up refreshed.

 

I am hesitating seeing a functional doctor because of the cost. I'm just not sure how to explain to my husband the difference between a traditional medical doctor, a functional doctor, and natural-type healthcare practitioners (of which he doesn't want me to go). Any suggestions?

 

My husband still thinks my whole problem is that I "drank too much water" and he feels he has to make sure I "don't drink too much water". I don't know how to explain this all to him.

 

One day I know we'll all wake up and know this wasn't all for nothing. That sharing our experiences will help others. That one day, we will all be taken seriously, and doctors will be taught about long term side effects and withdrawal effects of these drugs. I don't regret being on them 20+ years ago. They probably saved my life at the time and years after, since I was one of the those put on SSRIs/SSNRIs for clinical depression and anxiety that existed since childhood. But I'm healthy mentally and emotionally now because I worked extremely hard at changing my thinking and behavior. But not being able to get off the medication, and having side effects, protracted withdrawal, health effects, etc. (and being told it means the depression/anxiety came back, etc. when you know in your gut that's not the case), is just no way to live.

[apace41]

Hi, Serenity.  Sorry to hear you are struggling.

 

POTS is, at its essence, a disturbance of heart rhythm, i.e., the tachycardia that results from the condition causes various problems, including headaches, nausea, palpitations and fainting.  The tilt table and other tests to diagnose POTS are frequently administered by or at the request of a cardiologist as a result of their workup of the rhythms. 

 

http://www.medscape.com/viewarticle/717904_5

 

Your post is a little conflicted.  On the one hand you say:

 

I haven't pushed this too much with my current doctor, or gone just yet to see a functional doctor because I would be mortified if this was all a physiological reaction to stress.

 

But you also say

 

I am hesitating seeing a functional doctor because of the cost.

 

I understand the cost issue.  The "being mortified" issue seems silly to me.  If you have a concern you need to rule out, then you should not be restricted from doing that by some kind of personal embarrassment.

 

If cost were not an option, I would go to a functional doctor and get worked up and find out if there is anything at the core of this beyond a reaction to the meds.  That would give you the peace of mind you want.  If a functional doctor suspected POTS he would either do or order the test for that. 

 

It's good that your anxiety has improved.  That being the case, it seems unlikely that what you are dealing with is a stress-based response.

 

It really sounds like what you are dealing with is withdrawal from the sertraline and some bouncing around in dose along the way.  However, if you feel like there are still many open questions then you need to push forward with some kind of evaluation.  Only you can decide if the peace of mind will be worth the cost. 

 

Best,

 

Andy

[Serenity23]

I've made an appointment with a cardiologist who specializes in POTS and dysautonomia for August. I feel funny going since I never fainted, but I'll tell him my symptoms and go from there.

 

I may have found my answer to all the other health issues: MENOPAUSE. I've been in perimenopause since my early 30s. I'm now 47. It's young for menopause but my mother and sister were in it young.

 

I think this weird body temperature thing is actually some sort of "hot flash" that lasts for hours instead of the typical 10 minutes. This would make sense, too, why I cannot tolerate the heat anymore. The hot flashes are waking me up at night. It doesn't explain why my feet are ice cold at the same time, but at least I think I may be on to something here.

 

I am going to see my doctor today. I hate the thought of going on HRT because I am a DES Daughter, but I think I may have my answer. I'm also going to add 1 serving of soy foods a day (I had also been avoiding soy because of the DES Daughter thing).

 

I cringe to say this but I may ask him about going back on Trazodone so I can sleep. Or, a sleeping pill of some sort. I had to take 1/2 a Xanax last night because the hot flash thing was unbearable and long-lasting. I wasn't anxious, but I was physiologically anxious. Yes, I can now tell the difference because of all the self-improvement work I've busted my butt doing these last 4 years. I'm not sure if I'll be able to explain that correctly to my doctor. The Xanax only helped to a point. It took the edge off for me to not feed my mind on how bad I felt, and to do some deep breathing. I fell asleep maybe 30 minutes later.

 

HRT and Trazodone are the last things I'd ever think I'd have to do. So if anyone has suggestions/experience of what helped them with low estrogen type menopause symptoms, I'd be interested in hearing them. Note: I am assuming it's low estrogen because of my symptoms. I have not been tested. My obgyn told me she doesn't test hormones because they fluctuate too much.

 

Also if anyone has suggestions/experience about what to take when I can't sleep and the hot flash episode is unbearable, that'd be appreciated: Trazodone? HRT? Xanax? Something else??? (Please let there be something else non pharmaceutical or non addicting...)

 

My personal stress level has been bad lately so I am wondering if stress makes menopausal symptoms worse, or if this is just a progression of menopause.

 

I have to say this is not what I imagined mid-life to be like. I imagined myself eating what I used to consider the "gold standard" way of eating (can't follow that one anymore, doctor's orders), exercising (can't tolerate getting hot), avoiding stress, being off antidepressants, and sailing through perimenopause and menopause without issue.

 

At least I've finally after 40 years of being anxious and depressed, been able to change my mind and view things from a different perspective from a program I had been following that's similar to CBT, but this just puts a wrench into everything.

 

One more thing to share: I recently was dealing with a stressful event, and for some reason I decided to say the OCD thoughts I was having out loud (that gave my husband quite a laugh!). They went away! For some reason, saying them out loud made me see how absolutely silly they were, even if they could've been true in the past or something others said. I don't know how I thought to do this, but it helped the thoughts go away!

 

I'd like to try to do some weight bearing exercises. I have dumbbells at home, an exercise ball, and a medicine ball. I used to work out and I loved it. I get way too overwhelmed reading exercise info online or on pinterest. Does anyone have a *simple* exercise plan I can use that uses body weight and dumbbells? I think if I crank up the a/c and have Gatorade handy, I will be okay. But I just don't know where to start and anytime I got exercise plans at the gym, they were always too complicated. I'm not a gym member anymore.

 

I have a treadmill, too, that my husband uses but I am scared of getting hot, since I'll lose salt in sweat. But I do have gatorade in the house, as much as I hate the taste and sugar content.

 

I've been taking a yoga class once a week that I am enjoying a lot. It's a light type of yoga, different than the ones I used to take, but it's perfect for now.

[Serenity23]

Andy: Thank you for your post. I still have to discuss the functional doctor issue with my husband more. It's tricky. I haven't worked in a few years and I feel badly about the cost. Plus my husband is pretty traditional when it comes to doctors. I know he thinks seeing a functional doctor isn't necessary. I think if I were working, I wouldn't feel so badly about the cost and about advocating for myself. It's hard for me to explain to him why I want to see a functional doctor vs my regular doctor. My husband views health/medicine as "an entirely different language". I wish I knew how to explain why a functional doctor would be the way to go, especially with the risks and side effects HRT and another antidepressant would cause. I'm sure he'd go along with it if I knew how to communicate the reasons.

[apace41]

Hi, Serenity.

 

Have you ever looked around the website for the Institute for Functional Medicine?

 

Here is a link to their "Why Functional Medicine?" article.  Other good stuff on the site as well.  It might help if he read this.

 

https://www.functionalmedicine.org/What_is_Functional_Medicine/Why/

 

Below is a beginner's program for barbell work.  The site is "nerdfitness" so this should be a good starting point! 

 

https://www.nerdfitness.com/blog/2014/01/14/strength-training-101-where-do-i-start/

 

 

Best,

 

Andy

[brassmonkey]

PowerAid Zero, as good as Gatoraid and no calories.

[Serenity23]

PowerAid Zero, as good as Gatoraid and no calories.

Thanks Tom!! I'm sorry to hear you have bronchitis. I hope you feel better soon!

 

Thank you for letting me know about PowerAde Zero. I had seen that it compares well to Gatorade as far as electrolytes. However, it has artificial sweetener in it. I did buy some anyway, to switch off between the sugar from the Gatorade and the artificial sweetener from the PowerAde....

[Serenity23]

Hi everyone, I haven't updated in a while. It was a challenging summer with episodes of dehydration and near syncope. I had about 6 or 7. I still don't have any answers, really, as to what caused them. I had a table tilt test to rule out dysautonomia, but at 18 minutes in, I felt something very off and I couldn't continue the test. The doctor did say that my blood pressure started to drop at 18 minutes, but it didn't crash. If I could've endured the rest of the test, it could've helped get a possible diagnosis (there are other forms of Dysautonomia than POTS) but he just told me to increase fluids and increase salt, so I've been trying to do that. As soon as the weather got cooler, I felt much better, although I still am having some sensitivity to salt/fluid balance.

 

I am also still having migraines, although those, too, have gotten better since the weather got cooler, with a few exceptions. But the migraines have been around ever since the neurological symptoms first started to appear when I weaned off the Zoloft.

 

I was on 25mg Sertraline but in September I decided to increase back up to 37mg because I wasn't feeling right with the change in season. I seem to be doing okay holding on the 37mg. But now my insurance company has refused to let my doctor prescribe me 37mg (1 and 1/2 tablets). They told him his only option is 25mg or 50mg, so he told them 25mg. I do not understand why he couldn't explain to the insurance company why 25mg would be too low so suddenly for me.

 

How do I get my neurological system ready for going from 37mg for 3 months, to going back to 25mg so quickly? My psychiatrist unfortunately is still under the impression that stopping 25mg should be asymptomatic, and that going from 37mg to 25mg would be asymptomatic, since they're not clinical dosages like 50mg is. I'm going to have to call him and remind him what happened when I went from 25 to 12 to 0, and anytime that I followed his 3-week weaning schedule. I don't fault him because this is obviously what he was taught in school, but this just does not make any sense.

 

I just found this article after doing a google search and I was stunned!! That was exactly what happened to me! I wish I had found this article when I was in the hospital and was being yelled at by the physical therapist for "being anxious" when my balance was all off and wonky. https://www.ncbi.nlm.nih.gov/pubmed/11448088

 

I'm willing to go back to 25mg because I just don't know if I have the energy to fight this thing with the insurance company, but I need some advice as to how to avoid withdrawal and discontinuation symptoms.

 

I remember one time when I was speaking with the psychiatrist about trying to wean off zoloft again, he said "just try to go along with whatever side effects you experience." I didn't say anything, but I really wish I had the guts to open up my mouth and say "So, if I have stroke like symptoms again I should just "go with it?'" but I didn't want to insult him. But that is seriously what I am trying to figure out he meant.......

 

When are things going to change? Aren't there enough people having withdrawal and discontinuation symptoms that psychiatrists are being taught differently yet? I still remember the silence I got from the psychiatrist over 10 years ago when I told him about the "brain zaps" I was having when I discontinued Effexor.

 

I remember meeting an OT at a yoga class, and she told me that at the place she worked, she saw a lot of people with neurological issues from coming off of antidepressants but because there wasn't a stroke or actual diagnosis, they couldn't be helped. I just don't understand this.

[nz11]

Hi serenity

Sorry that you are being controlled by an insurance company.

I dont understand why the doc just didnt say 50 to the insurance company and then you covertly just stay on the 37mg.

Anyway maybe its a good thing to start to taper. Im surprised to read that you updosed from 25 to 37 because of the change of season.

So maybe this is time for a new season yet again. 

Well at the 10% taper per month you could be at 25 in 4 months so there is not a problem from what i can see if all goes well and you can manage the 10% drops.

Month1Drop immediately to 33.3mg

Month2 30mg

Month 3 27mg

Month 4 24.3mg call it 25mg for 25 mg will be provided by the insurance company 'right on cue'.

No problem, just dont let the doc push you there any faster.

 

Maybe you should update the drug sig.

nz11

[Serenity23]

Hi serenity

Sorry that you are being controlled by an insurance company.

I dont understand why the doc just didnt say 50 to the insurance company and then you covertly just stay on the 37mg.

Anyway maybe its a good thing to start to taper. Im surprised to read that you updosed from 25 to 37 because of the change of season.

So maybe this is time for a new season yet again. 

Well at the 10% taper per month you could be at 25 in 4 months so there is not a problem from what i can see if all goes well and you can manage the 10% drops.

Month1Drop immediately to 33.3mg

Month2 30mg

Month 3 27mg

Month 4 24.3mg call it 25mg for 25 mg will be provided by the insurance company 'right on cue'.

No problem, just dont let the doc push you there any faster.

 

Maybe you should update the drug sig.

nz11

Hi nz11,

I'm not sure why he didn't say "50mg" either but I'm assuming it's harder to cut those pills? But it could be because the last time I saw him--months ago--was to talk about weaning off the zoloft, and then a week ago I'm back telling him I wasn't feeling right in September when the weather changed (very lethargic, depressed, energyless, etc although he didn't ask specifically) and that I went back up to 37mg. So maybe that's why he said "25mg" instead of the 50mg, but I am not sure.He has no staff other than a receptionist so maybe he just didn't have the time to deal with it, I don't know.

 

I may be able to do the taper like you wrote here (thank you for listing it out for me, I appreciate that). I have some 25mg tablets from 2015 that I didn't use. They expired 11/2016 but do you think I could still use them for my taper? Otherwise I will not have enough pills to use, since I was using my 25mg tablets. I now only have 30 pills of the 25mg otherwise.

 

Let me write it more clear. This is what I have:

 

30 pills generic 25mg zoloft - just filled

83 pills generic 25mg zoloft (of another manufacturer, not sure that matters) - filled in 2015 and expired Nov 2016.

 

Following the taper like you listed means I won't have enough pills if I'm going to be at 25mg in 4 months.What should I do?

 

I am much calmer now then I was all this time on SA but I don't have the brain power to go through all my messages again. If someone could just give me a link of what supplements I should take, things to do while tapering, I would greatly appreciate that. I get easily overwhelmed and anxious on here and it makes things worse.

 

And about tapering--I do have one of those micro scales that I use to weigh loose leaf tea. What kind of knife do you all find best to use when dealing with cutting up pills? I have a pill cutter but it never seems to work right.

 

PS - I am scared.

[apace41]

As I said by PM, Serenity (reposting here for others to comment), I do not believe the "old" pills are "bad". The notion meds go bad on a set date has been disproven many times. I would use those to do a slower more careful taper back to 25.

 

Best,

 

Andy

[Serenity23]

I am relieved to hear this, and will use them.

 

Any suggestions about how to cut the pills properly using the micro scale, etc?

 

Also, any thoughts about my experience with needing to go back up to 37mg in September? I thought it was seasonal, but that's the million dollar question--are my symptoms due to depression/anxiety or are they due to SSRI withdrawal.

 

I'm so much calmer now but I do fear doing this taper, with the thought that I've been on meds for over 20 years and wonder if my brain will be able to function normally without them.

[apace41]

Serenity,

 

I do not think that you have some "underlying anxiety condition" that can only be treated by meds that have been demonstrated not to work in the majority of cases.  I think your brain adapted to them and they are not easy to get off of, as it takes time for the brain to rewire to work without the meds.  You will get there -- it will take time, persistence and some moments that aren't that great.

 

I would use the scale and weigh the pill before, cut it at about the middle and take the one that is at or above 50%.  If it's close, go with that one.  If it's over by enough, use your fingernail and shave off a bit and weigh it again.  When you are at or about 50%, you are good to go.  You don't have to be perfect -- just reasonably close.  

 

What you also need to do is find some tools that will help you self-soothe when the anxiety goes up.  Things to try include meditation, yoga, breathing exercises, positive affirmations, EFT (tapping), tai chi, qi gong, visualization, etc.

 

Chamomile tea is a great soother as is lavender oil in a diffuser or a lotion you put under your nose.  What you need to do is find the things that are calming for you -- they are out there.

 

To the extent your body allows, you should do gentle exercise and/or take walks.  It has been demonstrated that exercise is better than anti-depressants for anxiety and depression in randomized placebo controlled studies.  Most of us would never have taken these meds had we known that.

 

You are going to be okay.  You just need to believe that.

 

Best,

 

Andy

[Serenity23]

Serenity,

 

I do not think that you have some "underlying anxiety condition" that can only be treated by meds that have been demonstrated not to work in the majority of cases.  I think your brain adapted to them and they are not easy to get off of, as it takes time for the brain to rewire to work without the meds.  You will get there -- it will take time, persistence and some moments that aren't that great.

 

I would use the scale and weigh the pill before, cut it at about the middle and take the one that is at or above 50%.  If it's close, go with that one.  If it's over by enough, use your fingernail and shave off a bit and weigh it again.  When you are at or about 50%, you are good to go.  You don't have to be perfect -- just reasonably close.  

 

What you also need to do is find some tools that will help you self-soothe when the anxiety goes up.  Things to try include meditation, yoga, breathing exercises, positive affirmations, EFT (tapping), tai chi, qi gong, visualization, etc.

 

Chamomile tea is a great soother as is lavender oil in a diffuser or a lotion you put under your nose.  What you need to do is find the things that are calming for you -- they are out there.

 

To the extent your body allows, you should do gentle exercise and/or take walks.  It has been demonstrated that exercise is better than anti-depressants for anxiety and depression in randomized placebo controlled studies.  Most of us would never have taken these meds had we known that.

 

You are going to be okay.  You just need to believe that.

 

Best,

 

Andy

Thank you, Andy. I appreciate this all very much and I apologize to everyone else who posted previously. I really did want to taper back then, but if I could explain how the anxiety I was under while reading the posts was and how it kept me from processing anything, I would. Now my brain feels calmer and I feel that I can face the fear and DO THIS.

 

Thank you for explaining what you did about my brain adapting to the meds. When I hear that it's a sign I have an underlying issue and need the meds, vs having withdrawal symptoms, from doctors, neurologists, etc, it gets frustrating and I start to question my own truth.

 

Do you think 3 months is too long to have been on 37mg that I now do need to do an actual 10% taper? I am kicking myself for going up to the 37mg in September because now I wasted those 3 months + the 4 future months if I do a 10% taper back down to 25mg. The psychiatrist thinks I can just go back to 25mg "like that".

 

Thank you so much for spelling out exactly how to measure and cut.

 

Thank you very much for listing specific tools I should look into.

 

I am willing to do all these things you have mentioned and will push myself to do them.

 

Exercise is one thing I used to love but find it hard to push myself to do when I get like this. I really need to look at it now like I have no choice.

 

Question: I currently drink green or white tea, 1-2 cups a day, and 1 cup of half-decaf coffee. What is recommended I do about caffeine--and about carbs/sugar--during my tapering?

 

Lastly, I have Xanax for emergencies. I used it about 4 times this past year, at 1/2 a dose. Could Xanax still be used or would that defeat the purpose of the tapering?

[apace41]

Serenity,

 

My thoughts below:

 

 

Do you think 3 months is too long to have been on 37mg that I now do need to do an actual 10% taper? I am kicking myself for going up to the 37mg in September because now I wasted those 3 months + the 4 future months if I do a 10% taper back down to 25mg. The psychiatrist thinks I can just go back to 25mg "like that".

 

It's a little risky in my view to simply "go back to 25" at this stage.  Nobody knows how you will react.  I would start with 10% and if you have no adverse reaction, increase the cut or make the next cut after 2 weeks rather than a month.  Play it by ear and let your body be your guide.

 

 

Exercise is one thing I used to love but find it hard to push myself to do when I get like this. I really need to look at it now like I have no choice.

 

If you push too hard and have an adverse reaction to exercise you won't want to do it again.  Go slow and do things that are enjoyable for you (walking, stretching, etc.) and, again, play it by ear and how your body tells you to go.

 

 

 

Question: I currently drink green or white tea, 1-2 cups a day, and 1 cup of half-decaf coffee. What is recommended I do about caffeine--and about carbs/sugar--during my tapering?

 

Caffeine is one of those things that affect each person very differently.  I found it activating so I'm off my daily cup of coffee (and miss it terribly) but I know a lot of people on here who are not affected.  If you don't find increased agitation from the caffeine don't stop it because of some mythical guideline.  When it comes to diet, it is a long road but figuring out what works best for you is good for a lifetime.  Try eliminating some things from your diet (eggs, dairy, gluten, processed foods, e.g.).  See if you feel better and then add them back to see if they trigger you.  It is a trial and error process but well worth it for long term health even after you are off the meds.  (One addendum -- once you are off the processed foods -- stay off/don't reintroduce -- they offer you nothing).

 

 

 

Lastly, I have Xanax for emergencies. I used it about 4 times this past year, at 1/2 a dose. Could Xanax still be used or would that defeat the purpose of the tapering?

 

Very tough question.  If you are in a true, true, true emergency you have to do what you have to do to survive it.  It will not "defeat the purpose of tapering" but it can leave you with a second drug to taper if you use it too regularly. Again, if you can use other tools to cope you are better off, however, there are plenty of people that use a benzo as an occasional coping mechanism to taper the AD.  We certainly don't "recommend" it but we also recognize there is a reality to deal with.

 

Hope that helps.

 

Best,

 

Andy

[Serenity23]

Thank you very much, Andy. This was very helpful.

 

I double checked my calendar and it was October, not September that I switched to 37mg but I guess in the scheme of things it does not matter.

 

I did notice that the couple of days of taking 37mg from last year's pills and a different manufacturer, I am feeling off physically though not mentally. I'm not sure if this is common or not.

 

Ok I will start with the 10% taper and increase the cut after 2 weeks if I feel well, but after a month if I don't. I'm assuming from what I've read on SA that as one approaches the tiny doses, that's when things get more rough and so staying on lower doses for a longer time is more helpful, is that correct?

 

Must I feel 100% before making the next cut? How do you all determine the decision based upon the severity of side effects?

 

Some days my lethargy is so bad, (though not lately) that brushing my teeth and getting dressed takes all the energy I can muster. That is why I am concerned I won't have the energy to exercise. How do you all deal with days when you have extreme lethargy mixed in with anxiety? Those are the worst. Thankfully I haven't had them in a couple of months but I'm not sure what to expect with the tapering.

 

The other question I have is driving. How do you all deal with driving while having side effects? This question then leads me to the question on caffeine. I am planning on stopping my 1 cup 1/2 caf coffee but will be continuing my tea (green, white, oolong) if I can. I have in the past, however, turned to a cup of coffee if I need to drive and the lethargy is unbearable. How do you all deal with this issue? And do you think I would be able to still tolerate tea? I know I am chemically sensitive so I'm hoping this won't be issue. When you all talk about caffeine on here, are you just referring to coffee or does this include tea?

 

When I first tried to go off my SSRI, I ate extremely clean. It didn't seem to matter. But looking back, I realized that I was hardly eating any fat, and fat is healthy for the brain. Taking a fish oil pill probably wasn't enough. So this time around, I am planning on eating clean but with much more healthy fats. I do agree with what you wrote about processed foods. I will have to go down this road carefully, since last time I ate extremely clean it backfired into obsessing about it.

 

When you all get a migraine during tapering, what do you do? Coffee or Excedrin Migraine usually help me, but I'm thinking it'd be best to avoid those.

 

I will save the Xanax for a "true" emergency--severe panic attacks only. I admit I have taken them maybe 2-3 times this year at 1/2 a dose if I couldn't sleep and my insomnia was really bad (it was only really bad during the summer, when I could not tolerate the heat). What do you all do for withdrawal induced insomnia?

 

How do you all decide which supplements to take? I remember last year trying to read things on SA and just getting completely confused and overwhelmed about the supplements and people's reactions to them. Are there ones that seem to work best for generic zoloft withdrawal? I want to try Magnesium, for example, but the amount of differing opinions on which type to take makes my head spin.

 

How often should I post here once I start tapering? How do I strike that delicate balance between posting here, but not having my withdrawal symptoms lead to health anxiety, which I'm prone to?