rafatennis Clonazepam and Nortriptyline withdrawal

[rafatennis]

Hello, I'm tapering Nortriptylene and hit a rough spot at 16mg, I've been dropping 10% of the last dose every 4 weeks doing a water titration, I'm now holding at day 56 since the last drop, still symptomatic primarily low energy, pins and needles with the skin and some overactive adrenaline, I've decided to go slower switching to 5% every 3-4 weeks. Whenever is exercise I seem to get drained which has not been my pattern.I understand waves and windows and are experiencing those.  I also take 2 mg Clonazepam at night. My question is should I go ahead with the 5% drop down to 15.2 mg any advice would be appreciated. 

Edited July 26, 2017 by scallywag
merged topic

[scallywag]

Are your symptoms stable, as in they don't swing wildly within a day or from day to day? 

If yes, your idea of a lower % decrease sounds workable.

If no, you would best consider continuing to hold.

If you don't know, Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

[rafatennis]

Thanks Scallywag I would say they are definitely not swinging wildly so based on that you think I could go ahead and moved down tonight another 5%? thanks

[scallywag]

It's worth a try, rafa.  If you're not already doing so, please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

[rafatennis]

Hello, I am currently tapering Nortriptylene at a rate of 5% every two weeks and am now down to 11mgs. I also take 2mgs of clonazepam all at night, my concern is that it will likely take another 10 months to finish the Nortriptylene taper, should I pause and work on bringing the clonazepam down to a lower dose, I'm just concerned about staying on 2mgs clonazepam that long? any input would be helpful, I'm prepared to go either way. I've been on both of these meds for close to 20 years.

[ChessieCat]

Hi rafa,

 

I've asked the other mods for their opinion on this.

[Shep]

Hi, Rafatennis. Even though you're technically not looking to taper both drugs at once, because you're stopping one taper to start another drug taper, this thread may still be helpful:

 

Taper more than one drug at a time?

 

Alto made a comment in that thread that addresses the AD/benzo combination here:

 

http://survivingantidepressants.org/topic/1070-taper-more-than-one-drug-at-a-time/?do=findComment&comment=9185

 

Is the Nortriptylene sedating at the dose you are on?  If the benzo is helping you sleep, I would caution against removing it at this time with anything more than a microtaper. 

 

If you do switch over to tapering the benzo, please keep in mind that your current windows/waves action from your previous AD tapering may make it more difficult to know what is an AD withdrawal symptom and what is coming from the benzo taper, so extra caution is required. 

 

[rafatennis]

Good morning , I'm messaging you for some  needed advice. You've helped me with withdrawing from two medications and I want to see how to proceed. I also would like some help with editing my signature, not sure how to do that from my profile page. I'm currently at a dose of 9mg Nortriptylene doing a water taper. I have had many starts and restarts over the last twenty years but I will keep this email to updated info. I started in January 2017 tapering from 45mg 10% of the last dose every 30 days as advised on this forum. In mid July at 16mg I hit a rough spot and had to hold for 60 days, Alto suggested I go to 5% every two weeks and that has worked well until I hit I dropped to 9.5 mg on Jan 2nd 2018 and since I've had about as many rough days as just ok days, I dropped down to 9mg on Jan 15th. I'm thinking I may need to go to extending the time frame to 5% every three weeks, what is a good rule of thumb when we hit hard spots, I know that as the dose gets lower it may become more difficult and require changing % or length of time. I also take 2mg clonazepam at night but am following the advice to get off the AD first and then tackle the benzo, any help or advise would be appreciated. thanks

[rafatennis]

I would also like to connect with someone who uses this forum and may be working on the same meds in tapering to share information with and encouragement, it is difficult to find anyone who is taking the journey we have all embarked on. Don't know anyone I can pick up the phone and talk to who understands the process and ups and downs, I'm 56 years old and have been on clonazepam and nortriptylene for almost 20 years. I've done alot of research and recognize and am fully motivated to get through this and become med free. 

[Gridley]

Hello, rafatennis,

 

Here is how to edit your signature:

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly? 

 

Any drugs prior to 24 months ago can just be listed with start and stop years. 

Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 

• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• Link to Account Settings – Create or Edit a signature.

Here's a link to tips on tapering nortiyptyline:

 

Tips for tapering off nortriptyline 

 

Your plan to taper 5% every 15 days falls within the SA protocol of 10% per month, so that's very good.  Don't forget to hold for two weeks after each drop to allow your nervous system to become accustomed to the lower dose.

 

Best,

Gridley

 

 

[elbee]

Hey Rafa . . . I got your reply on my thread, and I'll reply here. 

 

You wrote . . .

 

Quote

Elbee, I see so many of your comments very similar to my own experience, thanks for putting them in writing, I've been involved with ACA and Al-Anon as an adult child of an abusive alcoholic and too experienced the panic and fear in my late 20's and was put on anti-depressant but still had no skills to start working on the behavioral issues, I got married went on with life coping as ACA'S do by striving to achieve, people please etc and crashed again in my late 30's and was not only put back on anti-depressant but they added Klonopin to the mix, I've also known as you stated that to fully heal and be conscious of my progress I needed to feel to heal so I've embarked on multiple attempts to get off these meds, I'm now on a plan that is getting me there but as you said it is a combination of avoiding behavioral acting out in other ways while we manage the med withdrawal. My connection with God is helping me to address those. I appreciate you writing about your story, I think my med signature should be visible when I hit reply, please write back if you have any other comments, I've been on varying doses of these two meds for about 20 years and as you do understand that my brain has to neurologically adapt to the drops and being without them.

 

I read through your thread and you've gotten what seems to be the best advice possible on here . . . when in doubt, hold. Being an ACA, it's understandable that you want to get this "damn med stuff" figured out and get on with things . . . and of course, who wouldn't, right? I have found Chapter 2 in the ACA Big Red Book (specifically, "Internal Modes of Thinking") really useful to help ground my worried mind through this tapering process. You want to do it perfectly (PERFECTIONISM), you want to fully understand the process and feel like you are always on top of it all (CONTROL), if you're not doing it completely right, you must be doing it wrong (ALL-OR-NOTHING THIINKING), and you don't want to make mistakes in the process (JUDGEMENTALNESS towards self / INNER CRITIC) . . . does this sound about right? And of course, while tapering, the internal body sensations can set off all the childhood triggers which can be SO TERRIFYING! 

 

I have to remember that I'm doing a lot of things at once in this "RECOVERY" process. I'm of course getting off meds that, like you, I've been on for a very long time. Being on these meds has "reshaped" (injured) my brain and it's going to take time to heal. Also being on these meds, it is my belief my whole physiological system was "numbed" and now as I "un-numb" it's an incredibly jolting sensation . . . panic inducing when I move to quickly! And as I begin to "un-numb" all the childhood stuff comes up to the surface. And of course I'm looking at all my "behavioral medicators" too very closely now. So like you noted, as I refrain from "acting out" with my laundry list traits, I'm going through another withdrawal process . . . detoxing from the "internal drugstore" (as ACA puts it). And for me, I also quit drinking alcohol, quit drinking caffeine, and quit smoking over the past few years. So with the tapering from psych meds, refraining from other chemical ingestion, and working to become more aware of and change all my Laundry List Traits behaviors, this is a LOT of detoxing! 

 

And it sounds like you are doing great. You're getting great information on here for the specifics of doing the med taper . . . and there are a LOT of amazing articles and threads to continue to educate yourself. Your coming to this website to get the information and support you need to do this taper is evidence of your willingness to reparent yourself. As the ACA solution states, "This is the action and work that heals us." Keep up the good work!

 

[rafatennis]

Thanks Elbee, I really appreciate the encouragement and support, you are dead on, I crashed my system this last drop and struggling to get stabilized, as alot of ACA'S do I was looking for the quick fix for the right reasons to get on with life and find out what's under these numbing meds. I tried like alot of others to rely on faith to bust through this quickly and after many unbearable big drops I realized I have to go this route and am thankful that this site and people like yourself are available to correspond with. I wrote today on another reply that I used exercise as well to help with the anxiety and psych med withdrawal temporarily can take that relief away as well. This particular drop was small 5% but I think i ignored the warning signs that I wasn't yet stabilized from the previous drop so this last two weeks has been especially difficult. I would really like to stay in touch, still trying to figure out some of the ways to best navigate this site. ACA and AlAnon have been  good  but it is so rare to find people taking on what we are and if they are they won't talk about it in group sessions. Finding info from Claire Weekes has been most helpful as now I'm much less fearful of the body sensations, it sucks to feel the malaise and nausea but the other stuff doesn't hold the power over me it used to, I'm not bewildered by it thus not adding second fear or panic. I'm thankful to have found her teachings. Look forward to corresponding with  you. Rick

[rafatennis]

On 6/18/2015 at 3:15 PM, chicken said:

Hi Raf,

I'm also tapering nortriptyline. I'm down to 5.5mg from 20 mg.

I too dissolve it in water and shake it really well.

 

I dissolve mine in 20 ml of water though. I have been reducing by 10%.

So far, it's going good.

Congratulations Chicken how are you doing since you completely tapered off the Nortriptylene? 

[chicken]

On 1/30/2018 at 9:00 AM, rafatennis said:

Congratulations Chicken how are you doing since you completely tapered off the Nortriptylene? 

Raf, If I make it until March I will have been off of Nortiptylene for a year. So far so good. No problems. Thank the Lord.

[rafatennis]

Great news yes thank the Lord I agree, I look forward to being where you are, how difficult was your tranzene benzo taper?  I was also curious on the Pamelor how low in milligrams did you get before you jumped to zero? thanks

[chicken]

9 hours ago, rafatennis said:

Great news yes thank the Lord I agree, I look forward to being where you are, how difficult was your tranzene benzo taper?  I was also curious on the Pamelor how low in milligrams did you get before you jumped to zero? thanks

My benzo taper was no problem. I've been on benzos at 3 times in my life and each time I had no problems coming off. However, I never stayed on a benzo more than a few months. If I remember correctly I dropped somewhere below 1mg of the Pamelor before stopping. Once I got down to 10mg of Pamelor I stopped have all the side effects associated with tricyclics, blood pressure, dry mouth etc.

[rafatennis]

15 hours ago, chicken said:

My benzo taper was no problem. I've been on benzos at 3 times in my life and each time I had no problems coming off. However, I never stayed on a benzo more than a few months. If I remember correctly I dropped somewhere below 1mg of the Pamelor before stopping. Once I got down to 10mg of Pamelor I stopped have all the side effects associated with tricyclics, blood pressure, dry mouth etc.

Thanks for the feedback of your experience, I'm at 9mg of Pamelor/Nortriptylene but have been on it for 20 years so have had some struggles but am determined to move forward, I appreciate you responding and again congratulations on your success! 

[chicken]

On 2/3/2018 at 10:09 AM, rafatennis said:

Thanks for the feedback of your experience, I'm at 9mg of Pamelor/Nortriptylene but have been on it for 20 years so have had some struggles but am determined to move forward, I appreciate you responding and again congratulations on your success! 

Getting to 9mg is  a lot of progress as 10mg is the minimum starting dose. I started out on 20mg and had a lot of side effects. I ended up having five cavities due to dry mouth and had to take blood pressure medicine due to high blood pressure. Never had blood pressure issues before or after Pamelor. Once I reached 10 mg all of this disappeared. So I think you are in a much safer area when it comes to the harm of this drug now that you have dropped below 10mg.

[scallywag]

On 1/25/2018 at 7:59 AM, rafatennis said:

Good morning , I'm messaging you for some  needed advice. ...

 

I'm currently at a dose of 9mg Nortriptylene doing a water taper. I have had many starts and restarts over the last twenty years but I will keep this email to updated info. I started in January 2017 tapering from 45mg 10% of the last dose every 30 days as advised on this forum. In mid July at 16mg I hit a rough spot and had to hold for 60 days, Alto suggested I go to 5% every two weeks and that has worked well until I hit I dropped to 9.5 mg on Jan 2nd 2018 and since I've had about as many rough days as just ok days, I dropped down to 9mg on Jan 15th. I'm thinking I may need to go to extending the time frame to 5% every three weeks, what is a good rule of thumb when we hit hard spots, I know that as the dose gets lower it may become more difficult and require changing % or length of time. I also take 2mg clonazepam at night but am following the advice to get off the AD first and then tackle the benzo, any help or advise would be appreciated. thanks

rafa -- I did get your PM. Thanks for posting the same question on the boards. I've moved it from the Tapering forum to here in your intro thread.

 

Bottom line: Going slower than previously and making smaller decreases is an excellent tactic to minimize the risk of symptoms.

Edited February 11, 2018 by scallywag

[ChessieCat]

Hi rafa,

 

I've moved your post to Lojo to his Intro topic:  lojo016-4-months-off-meds

 

 

[rafatennis]

On 2/11/2018 at 1:37 PM, scallywag said:

rafa -- I did get your PM. Thanks for posting the same question on the boards. I've moved it from the Tapering forum to here in your intro thread.

 

Bottom line: Going slower than previously and making smaller decreases is an excellent tactic to minimize the risk of symptoms.

I need some advice here please I dropped my Nortriptylene from 9.5mg water taper to 9mgs 42 days ago. I'm only able to exercise sparingly walk at best and I've been generally felt poorly most of this time with a few windows here and there. I'm kind of at a lose as to whether I should just move forward. I've been daily tracking symptoms and most disruptive are CNS over activation with pins and needles in skin, low motivation, focus problems as I'm still working, crying but that has been good because I have some stored trauma and sorting through things from childhood. I guess I don't really see much point in continuing to hold, I would drop likely to 8.6mg, any feedback would be appreciated. 

[ChessieCat]

On 12/02/2018 at 5:37 AM, scallywag said:

Bottom line: Going slower than previously and making smaller decreases is an excellent tactic to minimize the risk of symptoms.

 

Many members find that the lower their dose gets the slower they need to go.  This could be making lower reductions and/or holding for longer.

 

It is generally better to hold for longer than to try and reduce too quickly.

 

 

Q:  Have you been experiencing any additional external stressors?

 

Q:  Have you changed anything in your diet (supplements, food, liquid)?

 

Q:  Have you been having regular and nutritious meals throughout the day?

 

Q:  Have you been trying to push yourself to exercise too hard?

 

Q:  Have you had a cold or sickness, or dental work recently?

 

Q:  Has the amount of sleep/quality of sleep changed for the worse?

 

The above are all things which can increase withdrawal symptoms.

 

 

You might find these topics helpful:

 

Why taper paper: dose-occupancy curves

 

Stabilising After a Reduction - What Does That Mean?

Withdrawal Normal Description

 

Windows and Waves Pattern of Stabilization

 

Micro-taper instead of 10% or 5% decreases

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

[ChessieCat]

There are many existing topic on SA.  Before creating a new topic please do a search to see if one already exists.  Use a search engine and add site:survivingantidepressants.org to the search term.

 

I've moved you post to an existing topic here:

 

chinese-herbs

 

Also see SA's topic:

 

Acupuncture - Posts #6 & #8 (not detox or stimulation)

[rafatennis]

Titled:  Need some advice on when to continue tapering

 

Hello all, I've been on this site on and off for several years and have received great help here in working on tapering of two medications, Nortriptylene and clonazepam. I'm also going through some grief work related to childhood trauma, primarily being raised in an abusive alcoholic home.

 

In November of 2020 i was on 1.375mg clonazepam and 13.6 mgs Nortriptylene, it was a highly stressful time at work and with my family, I made a decision to increase the clonazepam back to 1.5 mgs in hopes of getting better sleep, I work in constriction supervision and was struggling with poor sleep and also some CNS related heat intolerance and CNS activation, high heart rate etc.

 

I'm more in touch with emotions now and am involved with a recovery group for emotional support as well as seeing a Somatic Experiencing therapist since October 2020.

 

My question is when are the conditions better to continue the tapering.

 

I would like to continue to taper off the Nortriptylene and then start on the clonazepam, I reinstated .125 of the clonazepam back in late Nov 2020 and my sleep did improve but I'm still having some wild swings day to day of just feeling ok to feeling emotionally and physically fatigued with headaches, pins and needles in my back and shoulders. I'm familiar from time on this site with the 10% max taper, preferred supplements etc, I'm wondering if I need to hold or take a small amount off either med, it seems I felt better overall before I reinstated the .125 mgs Clonazepam. I've been on both meds at different doses for almost 25 years. Any feedback would be much appreciated, thanks

Edited February 5, 2021 by manymoretodays
moved from tapering to Introduction topic, spacing for readability

[Shep]

Rafatennis, what time(s) of the day are you taking these drugs? 

 

Are you still taking the same supplements, including B12? Please also list what time(s) of the day you're taking the supplements. 

[rafatennis]

Hey Shep, I take both the clonazepam and the Nortriptylene all before bed, that has been consistent for about 20 years. I was advised recently to cut out the supplements for a 30 day period so I am with the exception of the B6, B12 folate which I take in the morning. I eat very clean, no caffeine , no alcohol, its been a rough stretch of working on some trauma from my past and that is good as I'm more in touch with emotions,  I've just felt poorly 75% of the time for the past 7 months or so, I have the occasional ok day, as I mentioned on the post from the other day, I've had some intense headaches and pins and needles feeling in my shoulders and back that is the most uncomfortable, I've dealt with it on and off before, really wondering how much the meds are playing in and when to move forward, thanks for your response, I stopped the fish oil and magnesium and Vitamin E 2 days ago so I don't think thats been a problem. 

Edited February 6, 2021 by rafatennis
left out info

[manymoretodays]

Hi rafatennis,

And welcome back.

I wonder if you could do a few days of notes for us, that would be really helpful.

Just do the time on the left, and then list your drugs, by name with dosages on the right. 

Then also on the right, note any supplements by name and dose, as well as log in symptoms as they occur, throughout the day.

There's a good explanation, and then sample note here:   Keep daily notes of drug schedules and symptoms to track patterns and progress

 

And great, on your unwavering consistency.  Tough to go through any trauma therapy, while in WD, or anytime really.  And so hugs.

It's possible that something might stand out from the notes though, as far as with the clonazepam, so do give those a try.  And then, once that has been looked at, and if you are feeling ready, I don't see why you couldn't begin tapering the Nortiriptylene again.

Are you still using a water based, home made solution?

How much had you been reducing by and how often?  Thanks.

 

Headaches, pins and needles can certainly be WD symptoms.  With me, those kind of symptoms certainly increased with stress too.  The trauma work can be stress, unfortunately.  For me, it was often just life happenings.  And now......finally med free, I get to work on trauma responses and processing........which is good. 

Paresthesia: pins and needles, numbness, tingling, burning sensations, aka neuropathy

Migraine, headache, neck ache/pain and head pressure

 

I honestly think you'll be ready to move forward real soon.  And you have been moving forward by HOLDING too.  The Holds can give the nervous system time to restabilize.

 

And best.  L, P, H, and G,

mmt

 

Edited February 6, 2021 by manymoretodays
links, additional

[manymoretodays]

Hey raf,

I just added some links and additional to the above.

Best. mmt

[rafatennis]

Thank you manymore I appreciate your response

[Shep]

22 hours ago, manymoretodays said:

I wonder if you could do a few days of notes for us, that would be really helpful.

Just do the time on the left, and then list your drugs, by name with dosages on the right. 

Then also on the right, note any supplements by name and dose, as well as log in symptoms as they occur, throughout the day.

There's a good explanation, and then sample note here:   Keep daily notes of drug schedules and symptoms to track patterns and progress

 

 

Rafatennis, as you're able, please see the link "Keep daily notes" in the above quote box. 

 

It's possible some of your symptoms may be interdose benzo withdrawal. By posting daily notes here in your thread, we can help you sort it out. 

[rafatennis]

Hi Shep, I reached out to you and several others over the last six years and I appreciate the advice. I'm getting in a bit of a desperate place physically and mentally. I'm recognizing at age 59 how much I've damaged my nervous system by going up and down on two primary meds. I've done alot of emotional recovery work and now realize after resigning from an unhealthy job I was employed with for 16 years that I'm struggling to find any balance where I am. I've been holding at 13.4 mg Nort and 1.5 mg Clonazepam since November 2020. I resigned from my job in March 2021 and some of the withdrawal symptoms are getting more severe, I'm unemployed, I live alone and am dealing with self harm thinking etc, my main symptoms are daily headaches, anxiety, exercise intolerance, difficulty focusing and or concentrating, memory issues,  depression, pins and needles (in my back primarily) fatigue and some fear of going out of my home.  I'm considering increasing my Nortritylene back to 45mg, a level I was at in 2019 briefly that helped me kinda reengage life and leave the benzo where it is at 1.5 mg.

 

I'm aware of the kindling effect potential, I've been holding both now for 8 months and with work removed I seem to be getting worse but know I'm not in a place where I can start to seek a healthier employment situation. My eating habits are very good and no caffeine or alcohol, supplements are fish oil, saw palmetto for prostate health and magnesium glycinate. any advice from this forum would be appreciated. I've spent alot of time in research on the dangers of psychiatric meds mainly through this site, Peter Breggin, Will Hall, etc. 

 

Thanks Rafa

[Shep]

20 hours ago, rafatennis said:

I'm considering increasing my Nortritylene back to 45mg, a level I was at in 2019 briefly that helped me kinda reengage life and leave the benzo where it is at 1.5 mg.

 

Since you haven't been at 45 mg since 2019, that may be too much of an increase. Your nervous system is likely destabilized and may hyper-react to that high a dose. 

 

20 hours ago, rafatennis said:

I resigned from my job in March 2021 and some of the withdrawal symptoms are getting more severe, I'm unemployed, I live alone and am dealing with self harm thinking etc, my main symptoms are daily headaches, anxiety, exercise intolerance, difficulty focusing and or concentrating, memory issues,  depression, pins and needles (in my back primarily) fatigue and some fear of going out of my home.

 

Some of these symptoms may not be withdrawal effects - they may be side effects, especially the benzo. Clonazepam is a very potent benzo. 1.5 mg of clonazepam is equivalent to 30 mg of Valium, so you may be having memory and concentration issues from that. Also, it's nervous system depressant, which may be where your depression is coming from. And now not working may also be leading to feeling anxious and depressed. 

 

If this is the case, increasing the AD is unlikely to help. Slowly tapering, doing lots of self care and focusing on a good life free of drugs may be the best path forward. At this point, you're also no doubt suffering from battle fatigue from being sick for so long. But you've made progress on your taper, so if you can focus on feeling better in the future, re-engaging in the world with a new job or new hobbies and relationships, etc., that will set yourself up for a much better journey off these drugs. Find ways of filling your time so you feel like you're making progress with new activities - a hobby or finding an online or in-person class, volunteering, etc. Boredom can make anyone feel quite alone in the world, so as you're able, try to stay engaged even in a small ways. 

 

I took a quick look at your benzo forum thread from and noticed this from 2019: 

 

On 4/2/2019 at 5:18 PM, rafatennis said:

Any feedback would be appreciated, I quit caffeine 5 weeks ago and switched over to a plant based diet in early January of this year.

 

Are you still on a plant-based diet? If so, are you getting enough B12 with your supplements? B12 deficiency can create these same symptoms. And then again, supplementing with B12 can also cause problems (see Vitamin B12: essential for mood, nervous system paying close attention to the items in red in that first post).

 

Some of us find that it's better to get our nutrition from food instead of supplements, so a plant based diet may not be best for some of us. Please research this and see if you fit into that category. I went from being a vegetarian for 32 years to switching to a modified Paleo diet during withdrawal and found that helpful. But again, it's individual, so google and see what you can find out what's best for you. If you do make a major switch to a new diet, please do so gradually, allowing your GI system and your nervous system time to adjust. 

 

[rafatennis]

Thanks for the feedback Shep, I agree that several of the factors/changes you mentioned above are impacting the way I feel. I was working with a counselor from Oct 2020 to March 2021 and she believed I was experiencing chronic stress/burnout from the job which I believe was a big part of the problem. So I resigned because I was paying attention to the signs and what was happening in my system, I attribute part of this healthy decision to being on lesser quantities of psych meds which helped me better recognize the job stressor. I live in Florida and was at times supervising on job sites in extreme heat which was also had a negative impact on my nervous system. 

 

In reference to the diet I started to bring lean meats back into my diet in November of last year and also discontinued the B6, B12, folate supplement because I knew I was getting the B vitamins now with beef, fish and poultry. I had a full blood panel performed in March of this year and my B12 was in good shape as well as cortisol and free testosterone. There have also been several family stressors that in the past would send me back to reinstatement of the meds, this time I really want to stay engaged in a full recovery, physically, emotionally and eventually drug free. I would like to get more active in other areas outside the home but find that lately I get the ramped up symptoms so managing where I can. Thanks again and if you have any other suggestions please respond. 

[rafatennis]

6 hours ago, rafatennis said:

Thanks for the feedback Shep, I agree that several of the factors/changes you mentioned above are impacting the way I feel. I was working with a counselor from Oct 2020 to March 2021 and she believed I was experiencing chronic stress/burnout from the job which I believe was a big part of the problem. So I resigned because I was paying attention to the signs and what was happening in my system, I attribute part of this healthy decision to being on lesser quantities of psych meds which helped me better recognize the job stressor. I live in Florida and was at times supervising on job sites in extreme heat which was also had a negative impact on my nervous system. 

 

In reference to the diet I started to bring lean meats back into my diet in November of last year and also discontinued the B6, B12, folate supplement because I knew I was getting the B vitamins now with beef, fish and poultry. I had a full blood panel performed in March of this year and my B12 was in good shape as well as cortisol and free testosterone. There have also been several family stressors that in the past would send me back to reinstatement of the meds, this time I really want to stay engaged in a full recovery, physically, emotionally and eventually drug free. I would like to get more active in other areas outside the home but find that lately I get the ramped up symptoms so managing where I can. Thanks again and if you have any other suggestions please respond. 

Shep, one more question based on your above comments. Since I'm likely at tolerance with the clonazepam at 1.5 mgs, would you recommend continuing to reduce the Nortriptylene when my nervous system is more stable or start reduction slowly of the Clonazepam? they both have a moderate interaction of increasing sedation. I realize the site recommends the AD first typically and I've been following that advice but do have concerns that might be best to work the benzo down when I'm ready to move forward? THANKS

[rafatennis]

Hello MMT, I was corresponding with Shep about my current situation and after looking back through my thread I recognized it would be a good idea to list what you mentioned above about current doses and what time taken and symptoms etc

 

Nortriptylene: 1each 10mg capsule I take orally, I then draw 3.4mgs with a syringe from a water mix of 20mgs Nort capsule powder and put the balance in the fridge, taken at bedtime 9:30 pm 

Clonazepam 3each .5mg tablets all at one time at night. 9:30pm

The medication protocol taken together at night has been consistent for the entire time I've been taking them

My sleep has been ok, usually wake up several times but average between 5-8 hours, before I resigned from my job in March it was more like 4-6 hours per night of broken sleep.

current supplements: fish oil one in the morning , saw palmetto one in morning, one at noon , magnesium glycinate one at night Doctors Best recipe

The headaches are most everyday and have been for the last 3-4 months, the pins and needles not everyday, but if I walk or try yoga they can start up.

the memory issues became more problematic these last few weeks, the concentration and focus problems approximately since February 2021,  

fatigue and exercise , heat intolerance pretty consistently a problem since  Nov 2020.

 

Let me know if I can provide anything else, thanks again MMT

 

 

 

Edited June 28, 2021 by manymoretodays
took out quote in report

[manymoretodays]

Hi rafatennis,

Looking on back, I do see that when you arrived in June of 2015, you began with the 20 mg nortriptyline and at that time clonazepam was at 2 mg.

So you've been going down, slow and steady, which is nice.  Even though it can get, and feel rather tedious, I think you are on the right track raf.  It's the turtle here, who goes slow and careful, listening to their mind body and spirit, who eventually wins the race, or gets to the place of healing.  So you are doing good!  Keep in mind the transition that you made in March too, that's an adjustment to transition into.  This will all be part of your "work" now, learning new coping skills, and continuing to titrate down a bit more.  It takes time.  I just lost my Mom, Muma, and just 4 weeks into that, and it still feels like a very different world for me.  This is grief I suppose.  Once again for me, learning self love, patience, etc.    Anyway, you can do this.  And I'm glad you are here to get some input once again, and support.

 

On 6/26/2021 at 5:45 AM, Shep said:

Some of these symptoms may not be withdrawal effects - they may be side effects, especially the benzo. Clonazepam is a very potent benzo. 1.5 mg of clonazepam is equivalent to 30 mg of Valium, so you may be having memory and concentration issues from that. Also, it's nervous system depressant, which may be where your depression is coming from. And now not working may also be leading to feeling anxious and depressed. 

 

And yup, as Shep said......some of the memory, concentration, and depressive like symptoms may be due to the clonazepam load.  Still better to keep doing a gradual reduction, with one or the other medication.

 

11 hours ago, rafatennis said:

Nortriptylene: 1each 10mg capsule I take orally, I then draw 3.4mgs with a syringe from a water mix of 20mgs Nort capsule powder and put the balance in the fridge, taken at bedtime 9:30 pm 

Clonazepam 3each .5mg tablets all at one time at night. 9:30pm

 

^ then shows:

9:30 pm or 21:30  13.4 mg nortriptyline and 1.5 mg clonazepam

 

11 hours ago, rafatennis said:

My sleep has been ok, usually wake up several times but average between 5-8 hours, before I resigned from my job in March it was more like 4-6 hours per night of broken sleep.

 

And then, to finish off a 24 hour period of daily notes, you could note your bedtime, and then the sleep that night.

 

I'll copy over a sample note for you to look at.  And then try to do a nice series of a couple of days and post those.  It's possible something might stand out, and/or some kind of splitting of your clonazepam dosage might help, prior to any further tapering of the nortriptyline. 

Give the daily notes a good try.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 
6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

6 a.m. Woke with anxiety (but less than yesterday)

 

Add in your supplements again too, after the time on the left, and then your symptoms as they occur.  The headaches, tingling, even when you are feeling foggy, or more lapsed in memory and cognitive skills.  Make it like a brain game.  And just so you know, it's not early dementia or something.  I've been there.......with the cognitive difficulties, and while no fun........IT GETS BETTER. 

 

I'll leave you with that assignment for now.

 

And best, keep on keeping on and at it rafatennis!

 

Love, peace, healing, and growth,

mmt