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MrsGreen: Withdrawal from Amitriptyline / Elavil


MrsGreen

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Hello to everyone.

 

I am new to this board and am hoping to find confirmation that what I am going through is due to withdrawal.

 

My story in short:

 

I took Amitriptyline (25mg) for 18 months for insomnia which set in after the birth of my child. I had never been a brilliant sleeper but it got too severe for me to be able to take care of my baby. A year later, following the diagnosis of a strong lack of iron, magnesium and VitB12 as well as possible hashimotos disease of the thyroid (I have antibodies), I decided to slowly taper of the medication, especially as it influences the thyroid, too.

 

I had a short rebound of insomnia when I was down to 20 mg. The insomnia is very heavy now that I am down to 2,5mg. I am hoping it will not return for good and have the strong feeling that it is a withdrawal symptom as I was doing rather well having taken iron and B12. Also, I have always been very sensitive to medication, e.g. anti-histamines send me to sleep for a day; flu medication does the same thing.

 

I admit to going down a bit to fast in between, I was going down by 0.1mg per day and sped up between 17 and 5 mg as I was doing so well.

 

Currently I have one reasonable night 6-7 hours sleep albeit with phases of being awake after my child has woken me. The next night is anything between 2-4hours. Either I go to sleep immediately but wake at 2am. Or I lie awake for four hours and wake at five in the morning anyway after about 3 hours of sleep. When I wake up early my heart seems to be racing. It is pure angst.

 

Obviously I am very scared that it will stay like this. I cannot find very much information about amitriptyline withdrawal on the internet.

 

Any advice, consolation or ideas greatly appreciated at this point. Should I stay at 2,5mg and wait?

 

Bless you all.

 

Mrs Green

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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  • Administrator

Welcome, MrsGreen. Thank you for joining our community.

 

It does sound like you have withdrawal symptoms. That pattern of insomnia is very familiar.

 

What you might want to do is stop tapering for a bit and see if your nervous system can catch up with the changes you've made.

 

Also, sometimes we find keeping the bedroom very dark with blackout curtains and wearing a sleep mask to block out morning light reduces that over-alerting in the early morning hours.

 

It's probably an exaggeration of cortisol, the "alerting" hormone, which naturally rises towards dawn and is stimulated by the light. Reducing light can help lower this peak.

 

It's too bad you were treated with an antidepressant instead of addressing your underlying B12 and mineral deficiencies. What did your doctor say about that?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi MrsGreen,

 

Welcome to the forum!

 

I don't know anything bout amitriptyline or tricyclics specifically, but I think with any of these medications tapering veeery slowly is important. I think sometimes they recommend going back up on the dosage slightly to a point before you started having trouble to see if you stabilize. However, wait to get better advice from other people with more knowledge on the forum.

 

I just wanted to say I feel for you with the insomnia and waking with a racing heart. I think that is one of the very worst aspects of withdrawal for me, and I can't imagine what you must be going through having to take care of child on top of it al! Given your underlying medical problems, however, it seems likely that with time you'll be able to taper off of the amitriptyline and be able to sleep well naturally by addressing the other problems as you have. So hang in there!

'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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  • Moderator Emeritus

Welcome to the forum MrsGreen. IMO, this is the best place to get advice. Alto has done much research and is very wise. I trust Alto more than any doctor when it comes to tapering and what helps. Everyone here is friendly and supportive.

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Welcome to the forum!

 

Amitriptyline is an old school anti-depressant of the tricyclic family and not prescribed much these days to treat depression because they have a high side effect profile. Some of the side effects are drowiness and muscle This is probably why it may be difficult for you to find information about withdrawal symptoms. But Amitriptyline is used to treat migraines and sleep disorders. Here are some linke about tricyclics, and as you will see in the wikipedia link that insommnia is indicated as a withdrawal symptom. And the crazy meds link shows that the recommended tapering schedule is to reduce it by 25-50 mg every five days. So I agree with Alto, you might want to stop the tapering and allow your neurotransmitters to adjust to the changes that are being made by the reduced dosage.

 

http://en.wikipedia.org/wiki/Tricyclic_antidepressant

 

http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Elavil

Withdrew cold turkey from six medications: Celexa, Zyprexa, Depakote, Ativan, Ambien and Phentermine in 2002. It has been 10 years since I told polypharmacy to take a hike and have joined this forum to let others know that success is possible and to hopefully save people from experiencing the suffering that I did under psychiatric "care".

 

MY STORY

 

"TENSION is when we try to be who we think we should be, RELAXATION is when we are who we really are."

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  • Administrator

Oooo, if you've already shown you're sensitive to withdrawal, that CrazyMeds taper is probably too fast. We suggest trying 10% of the current dose every month, current dose meaning the dose you've reduced to.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thank you all ever so much for your warm welcome.

 

I am staying at 2,5mg for the time-being. I can see a very slow improvement happening in that my last good night was restful and the last short night (yesterday) was a bit better. I am working on calming down the massive anxiety that I carry through the day - wondering how the next night will be.

 

Luckily, I have started cognitive behavioral therapy and have a few options now to calm down, albeit haven't much practice, yet!

 

I will keep on reporting for documentation, too. When one is sensitive to medication it is easy to believe it is the psyche only. The effect of these medications is shocking.

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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It does sound like you have withdrawal symptoms. That pattern of insomnia is very familiar.

 

Dear Alto,

 

by familiar do you mean the pattern during the bad nights that I reported about or do you mean that sleeping well one night yet not the next is common?

 

Also, if I reduce 2,5mg by 10 percent as a next step after stabilization and continue to reduce the next dosage -2,25mg - by 10 percent, how do I ever reach zero? When does the moment come to be able to quit completely?

 

Thank you so much,

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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  • Administrator

Yes, withdrawal insomnia is something many of us have experienced, exactly in that 2 a.m. wakefulness pattern you've described.

 

Your pattern is called "oscillating." Your body gets tired enough by the second night to get you to sleep more. But the insomnia can get worse, and you don't want that to happen.

 

It's a good idea to stay at 2.5mg until all your withdrawal symptoms go away.

 

Your math is correct. The 10% reduction formula is a geometric progression approaching but never equaling zero. At a very small dosage, when reductions no longer cause any withdrawal symptoms, you will want to simply stop.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thank you once again, Alto.

 

I will proceed that way. And reducing once a month has proven to be the easiest way to go I believe? That could easily mean another year or so... goodness!

 

I am learning to meditate and use relaxation music in the afternoon when my child naps. It is helpful but obviously I will need more practice.

 

What, in your opinion, could make the insomnia get worse?

 

 

Ever so glad to have found this board.

 

Thank you everyone,

Mrs Green

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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  • Administrator

Try reducing once a month. If you have no withdrawal symptoms, including exacerbation of insomnia, you can try reducing every 3 weeks.

 

Withdrawal symptoms can make people hypersensitive to a lot of things: medications, light, noise, foods, vitamin supplements. Any of these things can exacerbate withdrawal symptoms and disturb sleep.

 

Try very hard to wind down in advance of sleep: Lower lights and turn down the sound, don't do anything stimulating.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thank you Alto,

 

by the way you asked about what my doctor had said about the underlying deficiencies. Well, nothing. I was given the Amitriptyline having only undergone the most basic blood tests. Ferritin, B12 etc were what I payed out of my own pocket a year later. I had researched a lot on the internet and figured there must be something else causing this. I have just had my blood tested again today and am eager to find out how the values have changed now after supplementing (that was before the withdrawal). Also as to how my thyroid is doing, since the ami interferes with it, too.

 

Mrs Green

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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This is what is happening now:

 

I had a good night last Thursday to Friday. Since then I have "managed" to sleep 5-6 hours per night. I am still feeling shattered - as many of you have!

Can this be considered an improvement, the fact that the oscillating patterns seems to be breaking?

 

I sometimes go to sleep and wake up after about half an hour and have a hard time getting back to sleep. What causes this? Is that cortisol?

 

Thank you and bless you all!

Mrs Green

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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  • Administrator

Yes, this is good. It's hard to tell if it's a trend until it happens a few more times.

 

The light sleeping is caused by over-reaction of the alerting system. This is fueled by cortisol.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 3 weeks later...

An update on my situation and a question:

 

Thankfully my child doesn't wake at 2 currently. It was a disturbance and I couldn't go back to sleep. I did sometimes wake at 2 myself and be awake for 2-3hours or even the rest of the night.

Now, however every second night or more often I wake up at 4.

 

This morning I woke at 4 and was absolutely soaked in sweat. Couldn't go back to sleep.

Is that a symptom of withdrawal insomnia?

 

The pattern is getting a little better, I do get 5-6 hours and sometimes more. I do still take an hour to get back to sleep on the nights I do.

 

What am I trying to say? Progress is very slow, I am still at the end of my tether and very very exhausted. I am in constant need of support in the house, too.

 

I am at 1,5mg now.

 

I also have a thyroid condition (Hashimoto) which will be treated as of March. I wanted to wean off the antidepressant for starting with thyroid hormones. So I don't know how much this condition adds to my insomnia.

 

Does my "progress" sound like it is generally getting better to you? Does it ever get better??

 

Thanks for reading!

 

Mrs Green

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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  • Administrator

It sounds like slowing down your taper and stabilizing has helped you.

 

Yes, this is definitely improvement. You may wish to stay at 1.5mg for a good while and let your sleep pattern heal.

 

If I were you, I would postpone the thyroid treatment. Thyroid medication can cause overstimulation and insomnia. Wait until you are completely off amitriptyline, your sleep is normal, and you feel normal for several months, at least.

 

Withdrawal can also affect thyroid test results. You may wish to have them checked again in 6 months, you may not need medication.

 

Please put your withdrawal history in your signature, instructions here http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thank you Alto,

 

I haven't much time right now, just one little addition. As I have hashimotos disease treatment of the thyroid is necessary soon, so I am in a bit of a catch22 situation... I have a very good doctor here and will mention exactly what you said, she is very very knowledgable about the effects of antidepressants on the thyroid, too. Thank you so much Alto!

 

Yes, will update my signature.

 

All the best,

Mrs Green

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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  • Administrator

Hashimoto's is indicated by a test showing inflammation of the thyroid. It can take a long while (maybe never) for Hashimoto's to generate hypothyroidism.

 

In other words, Hashimoto's is something to be monitored, not treated -- if your thyroid hormones are otherwise normal.

 

I also have Hashimoto's, as indicated by thyroid inflammation. The test showing inflammation was at a peak when I was in acute withdrawal and has been steadily decreasing over the years. My thyroid hormones have been normal and I have no other symptoms of hypothyroidism.

 

There's some debate about whether premature treatment of Hashimoto's is helpful. You might discuss this with your doctor, who may be considering prophylactic treatment that may be postponed.

 

There is a lot of latitude in thyroid treatment. You would think it's one of those things where it's always clear what to do, but it isn't.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Dear Alto,

 

I am very grateful for this input. I had the diagnosis last August, my thyroid levels are low on the scale and there are antibodies but my thyroid was not inflamed at all. That is why I decided to withdraw from the amitriptyline first and then see.

 

I have had my levels checked again and they are very similar to what they were, a weeny bit better and the antibodies are a bit higher.

 

The debate about premature treatment is something I have read about and I tend to find myself stuck in the middle.

 

My homeopathic doctor checked my system and to my great surprise found nothing wrong with the thyroid but DID notice that serotonin, melatonin and many other sleep related body substances were out of sync. As are the brain parts that regulate sleep. No wonder... She is a very good doctor and I am taking homeopathy to support the withdrawal. It seems to be working a little bit.

 

That on a side note as I left her surgery wanting to continue with a very slow tapering / withdrawal and not treating the thyroid in any way. However the other side of the debate came up again and I figured it might be an idea to start treatment / felt insecure, unsure.

 

Thinking about it and reading your input I have now decided to just monitor my levels as you suggest as I feel greatly uncomfortable about taking chemical hormones on top of the withdrawal issues. Knowing my hypersensitivity I would probably go up the shoot!

 

My GP, by the way, also says to wait with thyroid treatment as the values are still normal. It is just the thyroid specialists who want to start treatment. Then, they don't know about withdrawal.

 

It is very good talking to you and it helps keep me on track. Some days I cannot believe what withdrawal is doing even though I KNOW what my body is having to cope with here.

 

Warm regards,

 

Mrs Green

June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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  • Administrator

It's always best to minimize additional stress to your nervous system while withdrawing, and adding thyroid hormone would definitely be a stressor.

 

If you can put it off, I would do that.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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