Health Organization for Pudendal Education

Hey folks,
I have weaned off tramadol before and had some narc withdrawl symptoms; but I did not really expect any kind of withdrawl syndrome when slowly coming off an antidepressant. I am very slowly cutting down my nortriptyline dose because I would prefer to get off of it now that I am recovering from surgery. It is related to tricyclic antidepressants such as elavi;l but has been described to me as "the next generation of tricyclics", or "tetracyclic". My Doc told me if reducing the dose is going to lead to inceased neuropathy symptoms, it will take at least a week or two, so I am going off very slowly: reduced from 50mg to 40mg this week and won't go down to 30mg unless I still feel OK in a couple of weeks.
My question is I have been feeling really weird and I am wondering if it can be due to a mild dose reduction in this med? I just did some travelling; but I've travelled much greater distances with much more sleep deprivation and not felt so messed up. I was gone Thurs - Sunday and when I got home Sunday night 8pm I passed out on the couch and nobody could wake me so they just left me there. I don't remember anything until 6:30am when my husband woke me up. I was very out of it and by 9am I fell asleep again until 1pm. I was still on the couch and my entire family was home for summer break plus my housekeeper was vacuuming and some builders were working on our roof, but I was unconscious through it all. I slept last night from midnight to 7:30am and woke up feeling hung over but I had someplace to go so I pulled myself together and got ready. I have had a high, spacey disoriented feeling, an optical migraine, trouble speaking coherently and I'm losing things. I also feel unmotivated to get anything done and kind of down although I have never had a problem with depression.
Has anyone experienced these things coming slowly off of an antidepressant? I am wondering if that is the cause or if I need to look further to figure out what the heck is wrong with me. Thanks.

Sounds a little scary HM. I've read unpleasant stories of other people coming off anti-d's so when I came off an SSRI after surgery I took an entire year to wean off slowly. Sounds a little extreme but I was very nervous about it based on what I had read. It wasn't too difficult until I came off the very last dose I did not feel normal for several months afterward.

I've also read that changing the dose of an anti-d can cause significant changes in body functions. For instance, one dose of zoloft can cause constipation while a higher dose can cause diarrhea. That is exactly what I experienced. Anti-d's can definitely affect levels of alertness and sleep patterns -- some people can only take them at certain times of the day -- otherwise they become too sleepy or have the opposite problem of insomnia. The point I am trying to make is that these drugs are very potent so I would not consider it a surprise what you are going through. I guess you could either try to tough it out or you could try to wean off more slowly.

Violet

Thanks, Violet, That makes me feel better because it makes me realize what I am going through is probably normal; but on the other hand it doesn't make me feel MUCH better because physically, I feel like dirt right now. I can't really wean slower because they are capsules not tablets. So I asked to be taken of a single 25mg tablet twice daily and put onto two 10 mg tablets twice daily. that means I can only cut down a full 10mg at a time. the tramadol was easier to wean from because they were tablets and I was able to cut thm into quarters. One thing is for sure I can't live like this for months, so I'll see how long it takes for me to feel 100% normal on the 40mg dose and then I will not cut down to 30mg until I am rested up and prepared to go through this again. It probably will take me a year to get off of this stuff too, *sigh*.
I have definitely been learning the hard way how important it is when choosing one's meds, to learn up front what it will be like to get off of them. it's a lot of stress to put oneself and one's family through: PN followed by surgery followed by withdrawl

Ugh! HM I feel for you.
I wish it was not the case but sometimes for the little good a drug does,I wonder if some are worthwhile taking at all.
When I had botox I tried to stop taking gabapentin and it was DREADFUL! I thought I must have a thyroid problem again (under active) as I had almost all of the symptoms except the weight loss bonus
Even tho' they worked a bit I am loathed to try them again it was so tough. I know that if I forget to take my antidepressant, I 'glow'. . . . . . .well, sweat like a pig tbh! and have THE most ridiculous nightmares (hunger games. . . . . . nothing!) and that is just one day without a lowish dose.
Hang on in there (which is what you do SO well ) One day, in the not too distant, you will be able to cross SO many things off your DONE list.
Helen xx

HM

I really feel for you right now and wanted to let you know that im thinking of you and hope that you can get through this tough time without too much extra stress which must be huge right now for you and your family.
Just a suggestion can you ask for your meds in pill format so that you can reduce the dose even more gradually? This may give your body much less of a shock when you take a smaller dose.
These medications are great when they work, but very tricky to come off.

Hang in there

Thank you Helen & Amanda for caring Fortunately it doesn't seem to be a long term reaction, I was feeling pretty good today and still not too exhausted although in every other way this has been the day from hell and I wish I HAD stayed in bed
Really my mistake was that I didn't expect to experience any side effects at all just from cutting the dose from 50mg to 40mg. Next time I reduce the dose, I will anticipate problems and put aside some down time on my calendar. I had applied for 1 job so far and been turned down, and now I am so relieved that I didn't get it because I realize I will probably not be in shape to work for a long time. It seems that the pattern is going to be I start feeling better from the surgery, drop my meds a bit, and then have withdrawl symptoms and also an up-tick in my symptoms due to less medication. So then I have to wait to improve some more and go through the whole mess over again.
Helen the gabapentin withdrawl is something I am not looking forward to at all: I am on an elephant's dose (2400mg daily divided into 4 doses), and if I miss a dose I realize it because I become profoundly tired. That is the 1st med I went on and will probably be the last I go off. I think I am going to put off applying for any jobs or taking on any long term volunteer commitments until I am off meds. This has been a wake up call that I can't make any reliable predictions about how I will be functioning over the next year or 2.

HM,
Good to hear things are settling down. Thank you and the others for the info on getting off the meds, I need to plan for this and work with the doctor. I may have to get am appointment soon while I collect things to talk about. Since I am working and have little time off I may need to put down withdrawal as a reason for medical leave act Leave Without Pay, they will love that! Fortunately my pain guy stopped me at 1800mg Gabapentin a day. I was not sure when to start getting off them, just passed my one year post-op. Best of luck and hope you can work a job or some volunteer work.
Janet

Janet,
I would dearly love to get off gabapentin because it gives me the memory of a 90 year old. But I expect it will be the last med they want me and you to get off of; because it is the only one given credit for promoting not just symptom relief but also nerve healing. When I say gabapentin is "given credit for" promoting nerve healing, what I mean is my practitioner told me that and I know a lot of other patients who were told the same thing by their practitioners. I don't know if there is a shred of research to back it up.
Amanda is right, too, it is much easier to wean off anything in pill form than in capsule form. The tramadol I literally weaned down to a quarter tab every 48 hours before getting down to zero. The result was, I only had serious withdrawl symptoms a couple of times when I reduced the dose too quickly. Since gabapentin is a tablet, we can probably get off it without a lot of problems if we taper the dose very slowly.
I just didn't expect this issue with an antidepressant. I feel so sorry for the poor people who take this crap for depression not neuropathy. Nortriptyline never made me feel happy, it made me fat and lazy like a neutered dog. And getting off of it is actually depressing! How folks with pre-existing emotional distress handle what the pills do to them is beyond me. It's great to have you guys around for support. keeps me from going onto facebook or some other inappropriate venue to babble about pill withdrawl

HM,
Thanks so very much again, you are a wealth of information and I hope all keeps getting better from your surgery. The effects vary for us and I lost attention to detail which really frustrates me at work, but I know it helps with the pain and if I need it for healing I will stay with it. I was not sure what to do but now I will wait, who knows maybe I can wait until I retire and no longer have to worry about time off. I may need to see about the tablet form as mine are capsules, another good tip. At least I won't have to go through this more than once since I only take tramadol and oxycodone as needed and I think I will stay on amitriptylene forever as it is for the nerve issues in my feet pre-PNE. Keep up your strength and resolve to beat all this obstacles and hope you get your good self back no on likes to feel 90 wk,hen they are no where near it!
Janet

I have to butt in and correct the misstatement about what gabapentin and neurotonin do. They do NOT heal the underlying neurological condition which causes the pain. Two neurologists told me this and I verified the fact by my own web research. I take Lyrica and I am pretty sure the manufacturer's literature states that the underlying condition isn't cured. I know of some people who have been on Lyrica for shingles and still suffer the same amount of pain as they originally did if they go off the meds or reduce the dose.

Both drugs are anti-seizure medicines which stop the nerves from firing. I would think that "giving the nerves a rest" but stopping the firing would help heal the underlying condition, but "no." I wish it were the case that these drugs healed the nerve but unfortunately they no more heal the damaged PN than they heal a damaged brain that is misfiring and causing seizures.