Honingbij: tapering off Amitriptyline again

[honingbij]

Hi everyone!

I'm here because I'm about to start to taper Amitriptyline 75 mg that I've been taking for my migraines.

This is not my first drug-tapering rodeo, but I'm still not looking forward to it.

I was first prescribed medication for my migraines in 2004. I was put on trials of amitriptyline, depakine and then topamax. None of these worked, and I had a severe reaction to the topamax that resulted in panic attacks, agoraphobia and suicidal ideation [i had a plan]. During this crisis, I was prescribed Ativan, but I became addicted to it after 8 weeks. I crossed over to Valium 10 mg and tapered off that in 7 months.

I was off all migraine preventative drugs for 6 years. Then my migraines started to become much more severe and frequent. After a lot of procrastination, I agreed to start Depakine again. Amitriptyline was added because I was having scalp allodynia – my hair and scalp always felt like it was on fire.

I tapered off the Depakine in 2013 because I was starting to feel very ill taking it and the side effects were becoming worse. I stayed on the amitriptyline and needed to increase the dose as my migraines and allodynia continued.

Last year, I tried to do a 10% taper of the amitriptyline, but was unsuccessful and needed to reinstate.

In the meantime, I started to do the program of Dr. David Buchholz, “Heal Your Headache”. Between the dietary prescriptions and the radical reduction of my migraine rescue remedies, my migraines became significantly better – less frequent and much less severe.

The funny thing is, now that my migraines are more under control, I feel quite well on the amitriptyline. The side effects – chronic constipation, chronic dry mouth and weight gain – are annoying, but manageable.

Nevertheless, I don't like the idea of being on it and would like to see if I can taper off it and still have good migraine control. If I don't, I'd rather try a calcium-channel blocker like verapamil or diltiazem.

Having done this before, however, doesn't make me any less apprehensive about starting the ordeal again.

I am planning to do a very slow taper this time, starting at a 2.5% taper and seeing how that goes. I also plan to do a liquid taper. I didn't know about this option in the past, but I think it will be ideal for me this time around

My plan is to begin next month. In the meantime, I am upping my supplements, getting my diet lower carb, so that I can get into ketosis, and preparing myself mentally for the long slog.

I do have a question: at the present, I am taking tablets for my daily dose.
Would it be preferable to start to take my doses of 75 mg as a liquid dose before I start the taper? Or is it advisable to continue with the tablets until I'm ready to start my first cut with a liquid dose?

Thanks for any counsel. I've been reading the forum for a few weeks now and already I have gotten so much information. Thank you for all you do!
 

[Petunia]

Welcome Honingbij,

I'm glad you have found the site helpful so far, thank you for posting your history in your signature, that makes it easier to understand your circumstances.

 

It looks like you are well organized and have a good plan, I'm sure you will be successful this time.

 

You may have already seen it but here is our Amitriptyline tapering topic:   Tips for tapering off amitriptyline

 

Because you are planning on tapering slower than 10%, you may also find this topic helpful:  Micro-taper instead of 10% or 5% decrease

 

To answer your question about when to change to the liquid. If I were you I would change before you started decreasing and give yourself some time to adjust to the different formula. Sometimes switching to a liquid can cause a slight, temporary reaction, so its good to give yourself some time to stabilize from this, if it happens, before you start to taper.

 

Please feel free to write whenever you want, you will find a lot of friendly help and support here.

 

Petunia.

[bubble]

Welcome from me too.

 

In addition to all the very helpful information Petunia gave you I would just liek to check one more thing.

 

You say that you weren't successful in coming off the drug despite 10 % reductions. How often did you take make them? We advise waiting for at least 30 days between making cuts. Just wanted to check on that...

 

Best,

Bubble

[honingbij]

Hi Bubble:

 

Actually, I made only one cut [from 50 mg to 45 mg] but had strong symptoms immediately. They built up and by day 6, I had a big, 3 day migraine crisis. I just threw the towel in at that point and decided I would try again later. 

 

It was that experience that decided me on doing a slow liquid taper.

[honingbij]

Thanks, Petunia for the welcome, advice and information. I'll do as you suggest. 

[ChessieCat]

Just noticed that you are online.  How are you doing these days?

 

[honingbij]

Titled:  Having problems holding dose, 2 weeks doing microtaper

 

I have been using the micro-taper technique for several years, with a lot of success [2.5% drop every week]. I am tapering amitriptyline.

Recently, however, I have run into a curious problem.

When it comes time to hold my dose for the 2 weeks, I am having problems with symptom flare up.

I have few, if any symptoms in the first days of the taper. They start to increase in severity from  about day 10 on, so much so that I am having problems holding for the two weeks. I can't even get to the 14 days many times.

When I cut earlier than the 14 days, my symptoms often become better immediately. It seems my brain wants me to cut, even though I haven't been able to hold the dose for the recommended 2 week window.

There are times I would like to hold a dose for even longer, but I am not able to do this, because of the uptick in symptoms.  I didn't have problems doing this when tapering from a higher dose; I am noticing it as I get to the comparatively lower doses [presently 10.7 mg].

I would love to be able to let my brain rest at a dose for a time, but it seems it doesn't like it. I don't want to push it, but I'm really at a loss as to how to proceed. 

Does anyone have an explanation for this phenomenon? Where symptoms get worse instead of better with a tapering dose?

Has anyone else experienced this?

Any suggestions on how I might proceed?

Thanks in advance!



 

Edited April 13, 2020 by manymoretodays
merged to introduction, from tapering, added title

[manymoretodays]

Hi honingbij and welcome back,  @honingbij

 

I found your most recent post and moved it from tapering, on back to your Introduction here.  This is like your Home page, and a good place to post your questions, around your case.  That way we've got your stuff all in one place too.  And welcome back too!

On 4/11/2020 at 4:16 AM, honingbij said:

When it comes time to hold my dose for the 2 weeks, I am having problems with symptom flare up.

I have few, if any symptoms in the first days of the taper. They start to increase in severity from  about day 10 on, so much so that I am having problems holding for the two weeks. I can't even get to the 14 days many times.

When I cut earlier than the 14 days, my symptoms often become better immediately. It seems my brain wants me to cut, even though I haven't been able to hold the dose for the recommended 2 week window.

There are times I would like to hold a dose for even longer, but I am not able to do this, because of the uptick in symptoms.  I didn't have problems doing this when tapering from a higher dose; I am noticing it as I get to the comparatively lower doses [presently 10.7 mg].

I would love to be able to let my brain rest at a dose for a time, but it seems it doesn't like it. I don't want to push it, but I'm really at a loss as to how to proceed. 

Does anyone have an explanation for this phenomenon? Where symptoms get worse instead of better with a tapering dose?

 

So, you are tapering the Amitriptyline still.  And thank you for updating your signature too!  Super.

 

Are you doing the brassmonkey slide method then.......where you basically taper 10% of your previous dose, but split it into 2.5 % tapers each week, for 4 weeks, and then HOLD for 2 weeks before resuming another taper?

The Brassmonkey Slide Method of Micro-tapering

 

Or just tapering 2.5% from each previous dose every 2 weeks?

What do you do when you can't HOLD the dose then?

And what kind of symptoms are you finding intolerable? 

This may help:

Dr. Glenmullens withdrawal symptom list

 

It may just be that you ARE tapering a bit fast.  Sometimes, over time all the previous taper reductions will catch up to us.  Or you may be getting to a more critical point, with the taper, and might need to taper even more cautiously.

 

Good, good that you are listening to your body.  And yes, sometimes, with a longer HOLD, you will actually re calibrate a bit, and your nervous system will have more time to adapt to the drug changes.  So, HOLDING longer is not always a bad thing.

 

Tell us a bit more.  I left a few questions for you too.

 

Best honing, L, P, H, and G,

mmt

Edited April 13, 2020 by manymoretodays
symptom list link, another ?

[honingbij]

@manymoretodays:

Many thanks for your reply and thank you for moving my inquiry! I had a suspicion that I had put it in the incorrect place. My apologies! It has, indeed, been a long time since I've posted, and I forgot the procedure.

 

1 hour ago, manymoretodays said:

Or just tapering 2.5% from each previous dose every 2 weeks?

What do you do when you can't HOLD the dose then?

And what kind of symptoms are you finding intolerable? 

This may help:

Dr. Glenmullens withdrawal symptom list

 

I am tapering 2.5% from each previous dose every 7 -10 days for 4 weeks and then holding for 2 weeks. Have I been doing it incorrectly all this time? So, I should have been doing only 2 cuts per month, holding for 2 weeks each? 😱

What I am doing when I can't hold the dose is cut again, sometime a smaller amount. I don't like doing this, but I feel boxed in and don't know what the best thing to do is. I've had pretty smooth sailing up to this point, but it's starting to get tricky for me, that's why I am asking for advice.

Would you advise me to try the BrassMonkey method of 10% split into 2.5% over 4 weeks with a 2 week hold?

My big, big withdrawal symptom is migraines, which is why I started taking the amitriptyline in the first place. Occasionally, it's insomnia, but it's the increased number and intensity of the migraines that's giving me problems. The funny thing is, most of the time when I cut, my symptoms decrease and they get worse about day 10.

I use Dr. Glenmullens symptom list religiously!

I would love to hold a dose longer at times. It's clear to me that I need to change what I'm presently doing with my taper.

I might add that I am doing part of my dose in tablet form, and part of it in liquid. I had tried to convert to all liquid, but I had a lot of problems with it.

I appreciate any further advice, because I'm really stuck.


 

[Altostrata]

If a 2.5% reduction every week has been working, why are you worrying about holding for 2 weeks?

 

On 4/11/2020 at 3:16 AM, honingbij said:

I have few, if any symptoms in the first days of the taper. They start to increase in severity from  about day 10 on, so much so that I am having problems holding for the two weeks. I can't even get to the 14 days many times.

When I cut earlier than the 14 days, my symptoms often become better immediately. It seems my brain wants me to cut, even though I haven't been able to hold the dose for the recommended 2 week window.

There are times I would like to hold a dose for even longer, but I am not able to do this, because of the uptick in symptoms.  I didn't have problems doing this when tapering from a higher dose; I am noticing it as I get to the comparatively lower doses [presently 10.7 mg].

 

On 4/13/2020 at 9:48 AM, honingbij said:

My big, big withdrawal symptom is migraines, which is why I started taking the amitriptyline in the first place. Occasionally, it's insomnia, but it's the increased number and intensity of the migraines that's giving me problems. The funny thing is, most of the time when I cut, my symptoms decrease and they get worse about day 10.

 

What symptoms get better for 10 days after a decrease? What symptoms get worse? Are you taking any other drugs?

 

Is your amitriptyline tablet immediate-release?

 

Amitriptyline and nortriptyline:
 

Quote

 

Nortriptyline is an active metabolite of amitriptyline by demethylation in the liver. Its pharmacologic profile is as the table to the right shows (inhibition or antagonism of all sites).[17][29]

Chemically, it is a secondary amine dibenzocycloheptene and pharmacologically it is classed as a first-generation antidepressant.[30]

These effects account for some therapeutic actions as well as for most side effects such as sedation, hypotension, anticholinergic effects, etc.[clarification needed] Nortriptyline may also have a sleep-improving effect due to antagonism of the H1 and 5-HT2A receptors.[31] In the short term, however, nortriptyline may disturb sleep due to its activating effect.

 

 

Nortriptyline has a half-life of about 18–44 hours (mean 30 hours). Amitriptyline has a half-life of about 20-25 hours.

 

This means that after you take one dose of amitriptyline, in a little while, it starts making nortriptyline. You initially feel effects from amitriptyline, then the active metabolite adds its effects as well. The two drugs overlap until the dose amitriptyline is fully metabolized, which takes about 6 x 20-25 hours or 5-6.25 days, then the nortriptyline effects take over. Nortriptyline is a stronger drug than amitriptyline.

 

Nortriptyline washes out in 6 x 18–44 hours or 4.5-11 days.

 

With nortriptyline, an active metabolite, a dose of amitriptyline has an effect over 20-44 hours. When you taper amitriptyline, you reduce both these drugs -- but the amount of amitriptyline in your bloodstream will lower at a faster rate than the nortriptyline, amitriptyline continually producing nortriptyline all the while.

 

My guess is when you reduce amitriptyline, you initially feel the benefit of less amitriptyline for 5-6.25 days, which is when the amount of amitriptyline gets lower in your blood level. However, as the amitriptyline goes lower, nortriptyline gradually dominates in your blood stream, which you feel a few days after the amitriptyline reduction settles. (If this theory is correct, you'd feel better for about a week after a reduction, then worse for about 4 days, then better 14 days after the reduction, when the nortriptyline bump has been metabolized.)

 

My guess is you're sensitive to nortriptyline. If so, reducing by 2.5% every week or 10 days makes sense -- with the continual reduction of amitriptyline, you are also reducing nortriptyline while benefiting from that 5-6.25 day holiday from amitriptyline.

 

[honingbij]

41 minutes ago, Altostrata said:

If a 2.5% reduction every week has been working, why are you worrying about holding for 2 weeks?

 

I was trying to follow the microtaper schedule of cutting once a week for 4 weeks and then holding for 2 to give my brain a rest.

 

41 minutes ago, Altostrata said:

 

What symptoms get better for 10 days after a decrease? What symptoms get worse? Are you taking any other drugs?

 

My migraines and scalp allodynia get better after the decrease. Nothing else gets worse; these are really my only noticeable withdrawal symptoms.

I am also taking 5 mg of melatonin at bedtime, as prescribed by my migraine doctor. She said that research shows that migraineurs have lower levels of melatonin than non-migraineurs.

 

41 minutes ago, Altostrata said:

 

Is your amitriptyline tablet immediate-release?

Yes.

41 minutes ago, Altostrata said:

 

Amitriptyline and nortriptyline:
 

 

Nortriptyline has a half-life of about 18–44 hours (mean 30 hours). Amitriptyline has a half-life of about 20-25 hours.

 

This means that after you take one dose of amitriptyline, in a little while, it starts making nortriptyline. You initially feel effects from amitriptyline, then the active metabolite adds its effects as well. The two drugs overlap until the dose amitriptyline is fully metabolized, which takes about 6 x 20-25 hours or 5-6.25 days, then the nortriptyline effects take over. Nortriptyline is a stronger drug than amitriptyline.

 

Nortriptyline washes out in 6 x 18–44 hours or 4.5-11 days.

 

With nortriptyline, an active metabolite, a dose of amitriptyline has an effect over 20-44 hours. When you taper amitriptyline, you reduce both these drugs -- but the amount of amitriptyline in your bloodstream will lower at a faster rate than the nortriptyline, amitriptyline continually producing nortriptyline all the while.

 

My guess is when you reduce amitriptyline, you initially feel the benefit of less amitriptyline for 5-6.25 days, which is when the amount of amitriptyline gets lower in your blood level. However, as the amitriptyline goes lower, nortriptyline gradually dominates in your blood stream, which you feel a few days after the amitriptyline reduction settles. (If this theory is correct, you'd feel better for about a week after a reduction, then worse for about 4 days, then better 14 days after the reduction, when the nortriptyline bump has been metabolized.)

 

My guess is you're sensitive to nortriptyline. If so, reducing by 2.5% every week or 10 days makes sense -- with the continual reduction of amitriptyline, you are also reducing nortriptyline while benefiting from that 5-6.25 day holiday from amitriptyline.

 

 

 

Thank you so much for that great information!
 

Yes, I think you're correct about the nortriptyline sensitivity. It has, indeed, been my pattern to feel good for a week and then worse. I have been holding my current dose for 16 days now, and I do feel better.

So, my question is: should I just taper 2.5% every week to 10 days without having a holding period at all?

[Altostrata]

2 hours ago, honingbij said:

Yes, I think you're correct about the nortriptyline sensitivity. It has, indeed, been my pattern to feel good for a week and then worse. I have been holding my current dose for 16 days now, and I do feel better.

 

Interesting. That fits with the theory.

 

My guess is you can make 2.5% cuts every week to avoid the nortriptyline build-up, until you get to 1mg. Then you might want to make cuts every 2 weeks to allow adjustment to low levels of both amitriptyline and nortriptyline and reduce risk of withdrawal symptoms from either. The lower level of nortriptyline may not trigger those symptoms you've been getting.

[manymoretodays]

On 4/13/2020 at 10:48 AM, honingbij said:

Have I been doing it incorrectly all this time? So, I should have been doing only 2 cuts per month, holding for 2 weeks each? 😱

What I am doing when I can't hold the dose is cut again, sometime a smaller amount. I don't like doing this, but I feel boxed in and don't know what the best thing to do is. I've had pretty smooth sailing up to this point, but it's starting to get tricky for me, that's why I am asking for advice.

 

No, you did nothing wrong honingbij.

 

3 hours ago, Altostrata said:

My guess is you can make 2.5% cuts every week to avoid the nortriptyline build-up, until you get to 1mg. Then you might want to make cuts every 2 weeks to allow adjustment to low levels of both amitriptyline and nortriptyline and reduce risk of withdrawal symptoms from either. The lower level of nortriptyline may not trigger those symptoms you've been getting.

 

And oooh, that's some good stuff, on the nortriptyline and and Amitryptiline, from Alto.  In that whole post to you!  Thanks Alto!

 

L, P, H, and G,

mmt

[honingbij]

6 hours ago, Altostrata said:

My guess is you can make 2.5% cuts every week to avoid the nortriptyline build-up, until you get to 1mg. Then you might want to make cuts every 2 weeks to allow adjustment to low levels of both amitriptyline and nortriptyline and reduce risk of withdrawal symptoms from either. The lower level of nortriptyline may not trigger those symptoms you've been getting.

 

Many, many thanks!
 

I do have one more question:

I take my dose every night at 9 pm and go to bed at about 10 pm.

When I am having withdrawal problems, I wake up with a bad migraine between 0100 and 0400, which is 4 to 7 hours after I've taken my dose.

Do you think it would be helpful if I started to take my dose later, and adjusted the time I go to bed?
 

[honingbij]

3 hours ago, manymoretodays said:

 

 

3 hours ago, manymoretodays said:

No, you did nothing wrong honingbij.

 
That's a relief!

 

3 hours ago, manymoretodays said:

And oooh, that's some good stuff, on the nortriptyline and and Amitryptiline, from Alto.  In that whole post to you!  Thanks Alto!

Absolute solid gold!

[Altostrata]

2 hours ago, honingbij said:

I take my dose every night at 9 pm and go to bed at about 10 pm.

When I am having withdrawal problems, I wake up with a bad migraine between 0100 and 0400, which is 4 to 7 hours after I've taken my dose.

Do you think it would be helpful if I started to take my dose later, and adjusted the time I go to bed?

 

Interesting again! More evidence that it's the metabolite. Does taking your dose make you sleepy?

 

Maybe you want to work around "withdrawal problems" with those 2.5% decreases weekly.

[honingbij]

1 minute ago, Altostrata said:

Interesting again! More evidence that it's the metabolite. Does taking your dose make you sleepy?

 

 

Maybe you want to work around "withdrawal problems" with those 2.5% decreases weekly.

 

Yes, about an hour after I take my amitriptyline dose, I start getting sleepy. I take the melatonin just before getting into bed.

So, do you think that I should maintain the same dose time and just do the 2.5% weekly drops?

I am reluctant to experiment with the timing of my dose without advice, in case that muddies the waters.

 

 

[honingbij]

46 minutes ago, Altostrata said:

Maybe you want to work around "withdrawal problems" with those 2.5% decreases weekly.

So, just to be clear: That would be 2.5% of whatever my current dose is?
 

[Altostrata]

11 hours ago, honingbij said:

When I am having withdrawal problems, I wake up with a bad migraine between 0100 and 0400, which is 4 to 7 hours after I've taken my dose.

 

When you are tapering 2.5% weekly, you do not get this regular symptom, correct?

 

If so, I would taper 2.5% weekly, calculated on your current dose. This is 10% monthly, it's not unusually fast, but may enable you to work around the regular emergence of the metabolite.

[honingbij]

2 hours ago, Altostrata said:

When you are tapering 2.5% weekly, you do not get this regular symptom, correct?

 

To be honest, some weeks I did taper 3-3.5%. I thought that as long as I was feeling well, I could cut a bit more while staying within the 10% per month limit. So I wasn't always totally consistent with the 2.5%.
 
I can see now that was not wise.

I will tighten up and stick strictly to the 2.5% per week and see what happens.

Many thanks, Alto. Your information has been invaluable.

 

[honingbij]

2 hours ago, Altostrata said:

If so, I would taper 2.5% weekly, calculated on your current dose. This is 10% monthly, it's not unusually fast, but may enable you to work around the regular emergence of the metabolite.

 

So, I can cut 2.5% every week without doing a 2 week hold at the end of 4 weeks?

[honingbij]

I just checked my data, and I have tapered 2.5% a week for the past 3+ weeks [I have held my present dose for 16 days].

I had migraines in the middle of the night 4 times during that period.
 

[Altostrata]

1 hour ago, honingbij said:

I just checked my data, and I have tapered 2.5% a week for the past 3+ weeks [I have held my present dose for 16 days].

I had migraines in the middle of the night 4 times during that period.

 

When did these migraines occur? If they occur regularly, that may help guide you in your tapering schedule.

[honingbij]

19 minutes ago, Altostrata said:

 

When did these migraines occur? If they occur regularly, that may help guide you in your tapering schedule.

One week they were on day 2, 3 and 7 of the taper
Another week they were on day 1, 2 and 10.

These are only the migraines that I've had in the middle of the night.

I have other migraines that occur during other times during the day. These are more like my "normal" migraines.

The middle-of-the-night ones are different and are always very severe. The pain quality is not the same; it's hard to describe exactly how that is. The only word I can think of is "chemical", although that is an odd way to put it. It just doesn't feel like my usual migraine pain. I always have to take my strongest rescue migraine meds for this kind, whereas I don't automatically treat my usual migraines with medication. I am very careful not to overmedicate my migraines.


 

[honingbij]

I wanted to add that this many night migraines in such a short time span is not usual for me. I do have them occasionally, but not as frequently as they have been in the past 3+ weeks.

It's one of the reasons I have asked for some help troubleshooting my tapering. I feel like I'm starting to get into the weeds.

[Altostrata]

4 hours ago, honingbij said:

I just checked my data, and I have tapered 2.5% a week for the past 3+ weeks [I have held my present dose for 16 days].

I had migraines in the middle of the night 4 times during that period.
 

 

I'm confused. If you're tapering 2.5% every week, how can you get a nighttime migraine on day 10? Wouldn't that be after an additional reduction?

 

Or are you reducing every 2 weeks, with no migraines days 11-14? When was the last time you reduced? Might be good to hold for now.

[honingbij]

5 hours ago, Altostrata said:

I'm confused. If you're tapering 2.5% every week, how can you get a nighttime migraine on day 10? Wouldn't that be after an additional reduction?

 

Or are you reducing every 2 weeks, with no migraines days 11-14? When was the last time you reduced? Might be good to hold for now.

I last tapered on March 31. I usually taper every 7 days. 

I usually do not hold a dose this long because of the problems I'm having as described in my post of April 11.

 

I was trying to follow what I understood were the guidelines of microtapering -- reduce every week x 4 [not exceeding 10%] and then holding for 2 weeks to allow the brain to stabilize. This worked well in the past, when my dose was higher, but is not working well now.

 

 I'm only holding this dose while waiting for clarification on how to proceed.

I'm still not clear on the answer to my initial problem:
Can I reduce 2.5% every 7 days without having to do the 2 week hold after 4 weeks, since I start to feel worse on day 10 when I try to follow to guidelines to hold?

[Altostrata]

12 hours ago, honingbij said:

I was trying to follow what I understood were the guidelines of microtapering -- reduce every week x 4 [not exceeding 10%] and then holding for 2 weeks to allow the brain to stabilize. This worked well in the past, when my dose was higher, but is not working well now.

 

12 hours ago, honingbij said:

I'm still not clear on the answer to my initial problem:
Can I reduce 2.5% every 7 days without having to do the 2 week hold after 4 weeks, since I start to feel worse on day 10 when I try to follow to guidelines to hold?

 

You don't have to do the 2-week hold if it doesn't work for you. Those aren't rules, they're a place to start. You modify your method according to how your own nervous system responds.

 

Please let us know how you're doing.

[honingbij]

Thanks for all the great guidance and information, Alto.
I'll give it a go and see where it takes me.
I will definitely post back when I've been further down the road a bit.
I'm very optimistic that this will work out.

[Gertie]

Hi honingbij,

 

My daughter takes 25mg amitriptyline and we just started her taper yesterday.  I'm in the US and the tablets are SO TINY it's going to be difficult to get accurate measuring because my scale is only accurate +/- 4mg.  If the tablet weighed more this wouldn't matter so much.

 

Anyway, I have a call into her Dr. to change her Rx to 10mg tablets.  That way I can do part pill,  and then make a liquid for the funky measurements (make my own by dissolving it in water).  I see that you are doing part pill and part liquid too, and that you said you had difficulty transitioning to all liquid.

 

My question is if the liquid you are using is a prescription liquid, or are you making your own with water.  I'm just trying to figure out if she might have issues by converting the tablet to liquid.  Like does that increase rate of absorption or anything.  

 

Great job with your taper so far.  I'm impressed with your steady progress.  I'm sorry you are experiencing migraines, those are the worst.  I hope your 2.5% steady taper without the 2 week hold works for you.

 

Thanks for sharing your story here - you may be helping me, because I can use your experience as a guide.  This is the only place to get REAL help, so the more people who are willing to talk about their experience, the better the information pool we have.

 

Thanks!

[honingbij]

Hello all. 

It's been awhile since I've posted, but now I have a big problem.

 

My taper has been going well, with the usual bumps in the road, but always manageable. The taper has slowed down to a snail's pace, and I am able to taper only very small amounts like 0.01 mg. I am tapering 0.025% every 3 or 4 weeks, and although it's been frustrating, it's worked. I'm able to be relatively symptom free most of the time.
 

Until this week.

I tapered from 4.18 mg to 4.17 mg on November 21.
On day 7-10 [November 28-December 2], I've had insomnia every night and was sleeping only 4 hours. I didn't think much about it, as that is often usual with me. Days 7-11 of my taper, the amitriptyline metabolizes into nortriptyline and I'm sensitive to it and usually have symptoms.

 

Tonight, though, at about 1930, I had a sudden anxiety attack out of nowhere that is still going on.

 

This has never been one of my withdrawal symptoms while tapering so far. I've been having strong symtptoms ever since and it's going on 7 hours now. I'm tachycardic, have a dry mouth, stomach cramps, racing, anxious thoughts and I'm very restless. Because of my lack of sleep over the past few days, I took 2.5 mg Valium at 2200 to help me calm down and in the hope that I might get some sleep. [I take this no more than 3-4 times a year]. It was ineffective, and so I took another 2.5 mg two hours later. Again no effect. I've been awake almost 24 hours.

 

To my question for the mods:
I think I need to reinstate. I know that this is not always desirable and that there are risks. I've never had to do it before, so I don't know what would be  reasonable. I hate to do it, but I can't manage this.

 

Can any of the mods please give me some advice as to what would be a good dose to reinstate to? And any other advice would be welcome.

Thanks very much in advance. I hope I've posted this correctly. It's been so long and my brain is so fried right now that I'm not sure.

[honingbij]

In the middle of the night last night, I took 0.1 mg of amitrityline,which brought me back to the amount I had tapered from 11 days ago. I felt much better during the day today, but now at 2030, I am starting to have some anxiety again out of nowhere. It's not as severe as last night, but I still feel it. I don't at all understand what is going on with me.
Can someone give me some advice?

[ChessieCat]

Thank you for updating your drug signature.

 

21 hours ago, honingbij said:

Tonight, though, at about 1930, I had a sudden anxiety attack out of nowhere that is still going on.

 

This has never been one of my withdrawal symptoms while tapering so far.

 

Some questions to ask yourself first.

 

Q: Were you experiencing withdrawal symptoms when you made the last reduction?

 

Q: Was their any change in the drug supplier?

 

Q: Did you miss a dose?

 

If no to all of the above, then when this sort of this happens it is important to be a detective and to look for non-withdrawal things that might have caused or contributed to this.

 

This to consider:

 

alcohol, sickness / injury, starting or stopping medication/supplements, vaccination, additional stress (job loss or change, financial issues, relationship issues, moving, holiday), loss of close relative / friend / pet, consuming new foods (MSG, which is a neurotoxin, artificial sweetners, new spices)

 

The Covid situation started early last year and things are becoming more normal but not going back to what they were pre-Covid.  Our world has been changed by what has happened and there is a lot of uncertainty that we didn't have before.

 

Even though we think we have been coping okay, I suspect that there are people for whom the stress builds up very gradually over time and that it can then rear its ugly head and they can't work out what has caused it.

 

I was watching a video yesterday and they had statistics of the increase in the number of people experiencing depression in American.  I think pre-Covid was 17% and post-Covid was 40%.  I cannot remember when the stats were taken.

 

2 hours ago, honingbij said:

I felt much better during the day today, but now at 2030, I am starting to have some anxiety again out of nowhere. It's not as severe as last night, but I still feel it. I don't at all understand what is going on with me.
Can someone give me some advice?

 

During the evening do you watch activating TV shows, listen to loud or upbeat music, use the computer/phone?

 

It is very important when you feel anxiety starting to not add fear to it (second fear).  Understanding what is happening can help with this.  When we are anxious/stressed we can feel sensations in our body and it is very easy to because scared/worried and make things worse.  See the diagram on this page which explains the different reactions that can happen in the different areas of the body:

 

https://www.getselfhelp.co.uk/anxiety-self-help/

 

You might find these helpful:

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk
 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk

[ChessieCat]

2 hours ago, honingbij said:

I took 0.1 mg of amitrityline,which brought me back to the amount I had tapered from 11 days ago.

 

For most psychiatric drugs it takes about 4 days for the drug to get to full strength in the blood and a bit longer for it to register in the brain.  The brain likes consistency so I think it might be better to continue taking the updose amount and not yo-yo your dosing and drugs.

 

21 hours ago, honingbij said:

Because of my lack of sleep over the past few days, I took 2.5 mg Valium at 2200 to help me calm down and in the hope that I might get some sleep. [I take this no more than 3-4 times a year]. It was ineffective, and so I took another 2.5 mg two hours later. Again no effect. I've been awake almost 24 hours.

 

Taking too much of a sedating drug can have a paradoxical effect, where it works the opposite of what the drug is supposed to do because the brain is trying to keep you alive.

 

21 hours ago, honingbij said:

The taper has slowed down to a snail's pace, and I am able to taper only very small amounts like 0.01 mg. I am tapering 0.025% every 3 or 4 weeks, and although it's been frustrating, it's worked. I'm able to be relatively symptom free most of the time.

 

Many members find that the lower their dose gets the slower they need to taper.  And yes, some have to go really slowly.

 

We need to listen to our body/symptoms and taper according to those.  Our brain dictates the rate.  From now on you might find it better to hold for at least 4 weeks.  And it is better to keep the withdrawal symptoms to a minimum so that we can live as normally as possible during our taper.  Brassmonkey's taper (10%/6 week) took 50% longer than the 10%/4 week taper but he was able to work all through it and got off successfully.  His Paxil had pooped out before he began tapering.

 

I understand how frustratingly slow it feels, but compare your current dose to what you were taking before.  It took me 6 years to get off 100mg Pristiq (with a few longer holds due to non withdrawal issues) but I had minimal symptoms.  It is better to go as slowly as your brain will allow than to taper too quickly.  And each reduction, however small, is heading towards you getting off the drug.

 

When I was taking tiny doses, I would tell myself that I didn't need the drug but my brain did.  And due to a radical change in my diet right near the end of my taper, I decided to hold for longer and reduce to a lower dose than I had planned to, because I didn't want to be wondering what was causing any issues if they arose.

[honingbij]

On 12/4/2021 at 12:10 AM, ChessieCat said:

Thank you for updating your drug signature.

 

Thank you for your thoughful and helpful reply, @ChessieCat!

 

On 12/4/2021 at 12:10 AM, ChessieCat said:

 

 

Some questions to ask yourself first.

 

Q: Were you experiencing withdrawal symptoms when you made the last reduction?

 

Q: Was their any change in the drug supplier?

 

Q: Did you miss a dose?

 

If no to all of the above, then when this sort of this happens it is important to be a detective and to look for non-withdrawal things that might have caused or contributed to this.
 

No to all of the above.
 

On 12/4/2021 at 12:10 AM, ChessieCat said:

 

This to consider:

 

alcohol, sickness / injury, starting or stopping medication/supplements, vaccination, additional stress (job loss or change, financial issues, relationship issues, moving, holiday), loss of close relative / friend / pet, consuming new foods (MSG, which is a neurotoxin, artificial sweetners, new spices)

 

I don't drink at all. No vax. No personal losses. Clean diet [90% carnivore]. Very stable personal relationships. Nothing on the list except that I did add one supplement to my long established regime about 3 weeks ago. I had noticed no problems with it.

 

On 12/4/2021 at 12:10 AM, ChessieCat said:

 

The Covid situation started early last year and things are becoming more normal but not going back to what they were pre-Covid.  Our world has been changed by what has happened and there is a lot of uncertainty that we didn't have before.

 

Even though we think we have been coping okay, I suspect that there are people for whom the stress builds up very gradually over time and that it can then rear its ugly head and they can't work out what has caused it.

 

I was watching a video yesterday and they had statistics of the increase in the number of people experiencing depression in American.  I think pre-Covid was 17% and post-Covid was 40%.  I cannot remember when the stats were taken.

 

Now, this may be something. I have thought I was doing very well, and was more irritated by the restrictions, etc. than anything else. I haven't been depressed or anxious about the virus at all. I don't work anymore, so that wasn't a problem and my husband was happily able to work from home.

 

But.

When the EU started talking about making the vaccines mandatory for everyone, and Greece and Austria actually did it, that has been very upsetting. I would say that I have been trying to manage my panic over that.

 

It's funny, but when I had my episode, I didn't connect it with that. Since it happened when I was in my "nortriptyline zone", I automatically assumed that was the culprit, because days 7-11 after my taper are usually when I have my worst problems.

 

It seems stupid of me not to have thougth about it sooner. But I don't spend all my time being worried about the possibility of the mandates. I'm certainly aware of them, but I've tried to push them to the back of my mind and carry on. But I have to admit, I have been feeling like I've been living under a dark cloud since the talk about it began.

 

 

On 12/4/2021 at 12:10 AM, ChessieCat said:

 

 

During the evening do you watch activating TV shows, listen to loud or upbeat music, use the computer/phone?

 

No. We don't have a TV, and we don't stream any movies or TV shows. I don't like listening to music at any time, preferring to have a quiet environment. With my migraine brain, I always try to keep my threshold as high as I can control. Loud music or sounds or a lot of stimulation is never good for me. I will even not walk into a store that's playing loud and raucous music and has a lot of bright lights on.

I stop using the computer a couple of hours before bedtime and I only use my phone for calls and the occasional text message. Some days I forget to turn it on!

 

On 12/4/2021 at 12:10 AM, ChessieCat said:

 

It is very important when you feel anxiety starting to not add fear to it (second fear).  Understanding what is happening can help with this.  When we are anxious/stressed we can feel sensations in our body and it is very easy to because scared/worried and make things worse.  See the diagram on this page which explains the different reactions that can happen in the different areas of the body:

 

https://www.getselfhelp.co.uk/anxiety-self-help/

 

You might find these helpful:

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk
 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk

 

Thanks for these links!

 

[honingbij]

On 12/4/2021 at 12:23 AM, ChessieCat said:

 

For most psychiatric drugs it takes about 4 days for the drug to get to full strength in the blood and a bit longer for it to register in the brain.  The brain likes consistency so I think it might be better to continue taking the updose amount and not yo-yo your dosing and drugs.

 

Yes, I was planning on staying on the updose for at least 4 weeks. 

 

On 12/4/2021 at 12:23 AM, ChessieCat said:

 

 

Taking too much of a sedating drug can have a paradoxical effect, where it works the opposite of what the drug is supposed to do because the brain is trying to keep you alive.

 

I hated myself for taking the Valium, and I was sorry I did it.

 

On 12/4/2021 at 12:23 AM, ChessieCat said:

 

 

Many members find that the lower their dose gets the slower they need to taper.  And yes, some have to go really slowly.

 

We need to listen to our body/symptoms and taper according to those.  Our brain dictates the rate.  From now on you might find it better to hold for at least 4 weeks.  And it is better to keep the withdrawal symptoms to a minimum so that we can live as normally as possible during our taper.  Brassmonkey's taper (10%/6 week) took 50% longer than the 10%/4 week taper but he was able to work all through it and got off successfully.  His Paxil had pooped out before he began tapering.

For the past 6 months, I've been holding between 3-4 weeks, but I will start keeping a solid 4 weeks at minimum. 

Until this past week, I've been doing OK with the withdrawal and have managed well. I do have bumps in the road where I have an uptick in migraines and insomnia from the withdrawal, but I've always been able to handle it.

 

The anxiety attack this week was out of the blue, and it's the first I've experienced since I started tapering the drug, 7 years ago. This past week, I had insomnia for 5 days straight, which was unusual. Since it was completely in day 7-11 of my taper, though, I assumed it was because of the nortripyline levels increasing and the amitriptyline metabolizing. It was extreme and outside of my normal experience.

 

I've been very fortunate that, so far, more migraines and insomnia are the only withdrawal symptoms I have ever had when I taper. I can say that I've had an easy time, although it's been at a glacial pace.

 

 

On 12/4/2021 at 12:23 AM, ChessieCat said:

 

I understand how frustratingly slow it feels, but compare your current dose to what you were taking before.  It took me 6 years to get off 100mg Pristiq (with a few longer holds due to non withdrawal issues) but I had minimal symptoms.  It is better to go as slowly as your brain will allow than to taper too quickly.  And each reduction, however small, is heading towards you getting off the drug.

 

I am getting very discouraged for the first time since this process began. I know I've come a long way from 75 mg. I'm so close to the end, but so, so far! I worry because I'm not young. I'm 67 and I feel like I'm going to be doing this for the rest of my life and I'm just getting tired. But I know it's absolutely impossible for me to go more quickly and I do not push it.

My greatest fear surrounding this very, very slow process is that something will happen, like me having to go into the hospital or something, where I'm not able control or even do my taper. I'm really terrified of being in a situation where I would be forced to either stop cold turkey or forced back on a higher dosage by circumstances I can't control. This freaks me out more than anything, and is the main reason why I wish I could progress faster and end this.

 

On 12/4/2021 at 12:23 AM, ChessieCat said:

 

When I was taking tiny doses, I would tell myself that I didn't need the drug but my brain did.  And due to a radical change in my diet right near the end of my taper, I decided to hold for longer and reduce to a lower dose than I had planned to, because I didn't want to be wondering what was causing any issues if they arose.

 

I like how you framed that - that you didn't need the drug but your brain did. That's helpful. I often think it impossibly absurd that a 0.01 mg decrease can cause me symptoms.

 

Update:

Since updosing on Thursday night, I am feeling much better and was able to get more than 3-4 hours of sleep last night for the first time in over a week. I have had no further anxiety attacks.

Many thanks, again, @ChessieCat for addressing my situation and giving me some things to think about. I really appreciate it.