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kesh: akathisia, parasomnia, anxiety

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kesh

Some history. I've been on and off Fluoxetine and Citalopram all my adult life. They helped me, side effects were few apart from a few weeks of akathisia 10 years ago that passed during fluoxetine initiation. One side effect coming off fluoxetine that same time was a minor version of what I'm now going through.

 

10 weeks ago I started getting woken up by very rapid heart rate, an adrenaline burst, at the very moment of falling asleep. Like a hypnic jerk, but not my muscles twitching, instead my heart racing. I also got the same racing while waking up. So a wake-sleep transition thing. I managed to get to sleep eventually and usually got a good night's sleep. 5 weeks ago it got worse, so I went to my doctor and he's arranging a cardiologist to look at me (long waiting times in UK). Two weeks of sleep deprivation later I'm an anxious depressed mess. Dr puts me on Fluoxetine suggests anxiety may be the cause.

 

I get akathisia bad, come off it, the doctor replaces it with low dose citalopram, which I'm tolerating. As well as low dose diazepam and zopiclone.

 

Nothing is helping with the sleep disorder, which I believe is a parasomnia, possibly caused by stress/anxiety, but now the cause of suicidal thoughts due to extreme sleep deprivation.

 

There's anecdote around that AD use or discontinuation cause such parasomnias.

 

Any advice?

 

Thank you, and good luck.

Edited by Altostrata
added screen name to title

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Altostrata

Welcome, kesh.

 

On this site, antidepressants and withdrawal causing sleep disruption is taken as a fact.

 

About 10 weeks ago, did you take any drugs? Such as an antibiotic?

 

Going on and off psychiatric drugs and having adverse reactions to psychiatric drugs, such as you've experienced with fluoxetine, can sensitize our nervous system to any neuroactive drug, supplement, even foods.

 

Getting akathisia to a recent dose of fluoxetine may have awakened this sensitivity. Did you start diazepam and zopiclone at the same time you started citalopram?

 

Please try to remain calm. It's very possible many of your current symptoms, including the insomnia, have been caused by drugs and adding and switching drugs have complicated your situation further. If you can unravel this, we may be able to reduce your symptoms.

 

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kesh

The thing that happened 10 weeks ago wss more work stress, particularly a repetitive set of computer tasks that went on for a weeks. I'm sure such things rewire your brain.

 

The zop and diaz were started at the same time as the cit.

 

Last night I slept well thank god.

 

Thanks for your interest.

 

 

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kesh

My doctor is reluctant to continue giving me diazepam, but happy to keep giving me citalopram. I have only been on 2mg diazepam a few weeks so he thinks I am not dependent, but I suspect I am.

 

I speak to him in a few days and will ask for a taper if he won't continue prescribing normally, and pray he doesn't say go cold turkey.

 

But this taper is the wrong way around. The advice here is to taper the AD first.

 

Anything I can do to make this bearable? I have been on everything only a short while (perhaps a month), so am hopeful not too much damage is done. But I'm probably AD kindled as hell from years of on/off AD use.

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Staz

If you've only been on diazepam for 2 weeks you may well be able to cut it down with minimum withdrawal. If I were you I'd do it now as I've seen people hooked on benzos in 3 weeks. The benzo is a bigger threat than the a/d issue at this moment in time. Just my opinion. I wish I'd had the good sense to drop it at two weeks as I've suffered for nearly 2 years on benzos.

Staz

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kesh

Thanks, but not two weeks. I'm nearly four weeks on diazepam.

 

I am thinking it might be good to do it first, because ADs have been helpful to me in the past, especially with sleep and anxiety, even with some temporary adverse reactions. But I want to get off everything. 

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Staz
44 minutes ago, kesh said:

Thanks, but not two weeks. I'm nearly four weeks on diazepam.

 

I am thinking it might be good to do it first, because ADs have been helpful to me in the past, especially with sleep and anxiety, even with some temporary adverse reactions. But I want to get off everything. 

You could probably get away with a quick taper in that case. Believe you me the sooner you stop your benzo the better as the longer you continue the harder it gets.

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manymoretodays

Hi kesh,

 

Can you add the zopiclone to your signature?  That should prove helpful to you, as well as us, in the long run.  Also include any medications/drugs used in the last 12-24 months.

 

I did notice your other posts as well, about your Diazapam.  It might be best to post that kind of thing here in your introduction, for now. (we mods often do move that stuff as well, to keep everything in one place).  Your introduction can act as a kind of journal for you.  Unfortunately........ often none of this goes really quickly.......the tapering and eventually getting off of medications/drugs.  So hopefully.......it will be more helpful to you to see some of your progress all in one place.

 

We also have a members only benzo forum, where you might want to start a topic and post as well. 

 

So, you have been on the Diazapam since December 13th?  And your prescriber would like to discontinue that soon?

 

Are you interested in coming off all your medications at some point? 

 

I can only imagine how you are feeling right now........you have rapidly reduced your citalopram,  after a recent C/T from fluoxetine.  And also started the diazapam and propranolol on December 13th........as well as zopiclone.  Did I get all that correct?

 

And so.......you were medication/drug free up until the time of your stressor 10 weeks ago?

 

On 12/20/2017 at 5:02 AM, kesh said:

The thing that happened 10 weeks ago wss more work stress, particularly a repetitive set of computer tasks that went on for a weeks. I'm sure such things rewire your brain.

 

The zop and diaz were started at the same time as the cit.

 

Last night I slept well thank god.

 

Thanks for your interest.

 

 

 

Could you also put all of your present medications into the drug interaction checker at drugs.com and then share those results with us here. 

(if possible......:blink:B).........I'm wondering now on my own choice of bright blue above, it's a bit........well........?)

 

Good job on finding your way around the site as well.   There is a wealth of collected information here.  And.......welcome aboard survivingantidepressants!  From a fellow passenger.  :)

 

Best, and Love, peace, healing/inrecovery, and growth,

 

manymoretodays

Edited by manymoretodays
additional thoughts and comments

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kesh

That's my thoughts sometimes. A long taper is just more time to get more hooked. But I'm new to this.

 

 

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kesh

Have added Zopiclone. Am successfully off it. Have just had four quite good to excellent nights' sleep in a row. This thread's title was written during a catastrophising anxiety bout. You are correct in your description of my med history. And I was drug free before the 10 days of fluoxetine which began on Nov 25th or thereabouts.

 

I am interested in coming off all meds. But am somewhat split. In the past AD's have helped me a lot, and I have got off them painlessly. But I now suspect I am kindled (though my high anxiety may be making me fear the worst). 

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manymoretodays

Awesome.  I did a bit of editing to my post as well.  And excellent on the sleep improvement!

Edited by manymoretodays

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Staz
25 minutes ago, kesh said:

That's my thoughts sometimes. A long taper is just more time to get more hooked. But I'm new to this.

 

 

You are correct. You will just get hooked. Get off now while you still can. You may get some sxs but dragging it out will only get you to the place I'm in and I wouldn't wish it on my worst enemy.

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kesh

You asked for interactions, they are.

 

Propanalol and citalopram may cause irregular heart beat and the effects of that (dizziness, shortness of breath, cyanosis, etc).

 

Diazapam and citalopram may potentiate each other's sedating effects, so confusion, drowsiness,  poor motor coordination.

 

Propanalol and Diazapam lists nothing of note.

 

As I'm on very low doses I'm feeling fairly ok about these.

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manymoretodays

Seriously.......you're feeling okay about those drug/medication interactions?   Are you driving?

 

Do you have heart arrythmia's or high blood pressure or is your prescriber using the propranolol for anxiety/W/D symptoms?  40 mg. is indeed a very high dose for anxiety/W/D symptoms.  Propranolol should also be treated as a medication to taper off........probably more judiciously than your prescriber will recommend.

 

I don't think a daily dose of 2 mg. of diazepam is particularly low either.  Is this your first time on a benzo?  

 

The dosages may also be a bit irrelevant overall.......as far as safety goes at this point, with your history of going on and off medications. 

 

It's a bit concerning......the whole picture. 

 

I will just refer you back to the tapering section in the forums and encourage you to read a couple of the pinned topics at the top:

 

why taper by 10%,

as well as the tapering FAQ's(especially encouraging you to read Dr. Glenmuller's W/D symptom checklist and use it,  keeping notes on paper, rating daily symptom patterns.  How to talk to your doctor. What to expect from your doctor. As well as brain remodeling)

 

It does sound like you are still "somewhat split" as far as your decision making goes around coming off medications.  You might also consider posting on our benzo forum for some more experienced advice on getting off your diazepam and just to get some more input, that may be to your benefit, when you next see your prescribing doctor.

 

I honestly think it isn't a bad idea to just HOLD right now for just a bit longer, due to so many changes recently.

 

Do take a look at some of the pinned topics as well at the top of Symptoms and Self Care and see what seems to suit or help.

 

Best, love, peace, healing/inrecovery, and growth,

 

mmt

 

 

Edited by manymoretodays

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kesh

Thank you for taking time to reply. This is great support. 

 

My fear of holding is that it will entrench the Diazapam addiction, as I have been on it a much shorter time than most, I am having to balance the positives of holding, with the increase of my dependence through holding, a dependance that may not be fully established yet.

 

I think I have used benzos four times in the past. Single dose  years apart. A single pill given by a friend. So I doubt I am benzo kindled. I don't drink, and only drank occasionally in the past. (I believe cross kindling can occur with benzos and alcohol).

 

I have posted about faster tapers for people on low dose, short time benzos in the benzo forum. One reply only that said get off ASAP, but not sure how authoritative that reply was.

 

2mg is a lower starting dose than anyone here that I have seen, including equivalent doses of other benzos.

 

Iirc 40 to 60mg propanalol per day is standard for anxiety in UK prescribing guides.

 

The propanalol is indeed another thing I mean to come off. As is citalopram, as is tobacco. 

 

Right now I am beginning to feel the confidant, mood-lifting, sleep stabilising effects of the citalopram. This may give me the strength to lower the Diazapam (as Ashton believes, though this site generally doesn't), but the Diazapam and propanalol may be masking citalopram side effects of agitation.

 

I don't drive, and have had my heart checked out for arhythmias.

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manymoretodays

At the bottom of the Forums list(Support) on the Home page there is a section titled:  Members- only benzo forum.  You should be able to start a new topic there........there is a new topic button at the top right of the forum list as well as several pinned topics to read.  Many of the pinned topics are not open for further comment but provide relevant information.

 

The posts that you mention posting are currently in the Tapering section of the Forums(Support).

 

:wub:  I shall try and link you up with some of the items I mentioned in my previous post ASAP.  Meantime, do try for a daily entry either here, or on paper of:

 

drugs/medications taken in the am, dosages, and symptoms

 

drugs/medications taken in the afternoon, dosages, and symptoms

 

drugs/medications taken in the pm, dosages, and symptoms

 

drugs/medications taken in the night, dosages, and symptoms

 

I think you'll find this will prove to be helpful.  As well as looking at some of the items I posted in my post above.

 

 

 

1 hour ago, kesh said:

My fear of holding is that it will entrench the Diazapam addiction, as I have been on it a much shorter time than most, I am having to balance the positives of holding, with the increase of my dependence through holding, a dependance that may not be fully established yet.

 

I agree.

 

Are you still under the work stress now?

 

Edited by manymoretodays
grammar, clarity

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kesh

No. I had to quit work and go and stay with family because I was so bad. I'm pretty sure that level of bad was the high dose (for me) of SSRI. Now much reduced.

 

I will start posting my meds and symptoms in this thread. And I will make a post in the benzo forum. 

 

Right now though I'm going to enjoy feeling relatively normal and not think about all this horror for a few hours. 

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kesh

So I haven't slept. It's nearly 5am and know that I won't sleep. If I don't sleep the dreadful agitation returns. Idk if it's true akathisia or whether it is just agitation. Soon will follow huge anxiety and suicidal ideation. Absurd what missing a night's sleep does to me.

 

I cut to 1.5mg diazepam 5 days ago. Even though I was writing here I was on 2mg. My need to lie to doctors (as being straight with them doesn't often work), seems to have crossed over to here. My apologies. 

 

Great sleep for 5 nights and now this.

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kesh

Today's dose/symptom diary.

 

Early morning 2.5mg citalopram 10mg propanalol

 

Lunchtime 10mg propanalol 

 

Evening 10mg propanalol

 

Before bed 1.5mg diazepam  (day 6 of cut from 2mg) 10mg  propanalol. 

 

10 cigarettes through out day.

 

Symptoms. No sleep last night. Waves of agitation and restlessness that last a few hours. Not nearly as severe as I've known it. Tingly electric feeling in extremities. Together with anxiety, mind running over if this cut is the right thing. Will I have symptoms forever. Catastrophising. Between times feel normal, confident I'm doing the right thing. Some slight twitching now and again. 

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manymoretodays

Good job kesh,

 

I saw that you got started on the benzo forum too.  Excellent.

 

Yes, the honesty is good too.  When you do go in and talk to your prescriber, it may be a bit difficult.  To explain all that's going on and your new understanding.......all while hoping to get the prescriptions that you need, to do further tapering with.  You don't have to totally educate your prescriber.  Perhaps work on a script for your next visit.

 

Going through this stuff is tough.  And you may continue to find postings specific to you a bit conflicting/confusing.  In the long run though, you will grow I think.........in that way where you can learn to discern,  and make some of your own decisions.  You sound very bright.......I'm referring to one post of yours regarding receptor capacity.

 

Do try and take a look at some of the books and links that Shep gave you.  Anatomy of an Epidemic(book) made so much sense to me, yet, it still can be difficult, why others don't all realize the simple problem sometimes, that our drugs/medications can keep us sick, make us worse,  more often than not.

 

You won't have symptoms forever.  And sleep kesh sleep........I hope tonight goes better in the sleep department.

 

Love, peace, healing/inrecovery, and growth,

 

manymoretodays 

Edited by manymoretodays

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kesh

Thanks manymoretodays. Last night's sleep was beautiful, 10 hours. Quite twitchy today with that SSRI good mood. Classic effect of a few weeks on SSRIs for me. Used to like it, but now it just rings alarm bells.

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kesh

Today's dose/symptom diary.

 

Morning 2.5mg citalopram 10mg propanalol.

 

Lunchtime 10mg propanalol.

 

Evening 10mg propanalol

 

Before bed 1.5mg diazepam  (day 7 of cut from 2mg)

 

8 cigarettes through out day.

 

Note, this is a reduction in propanalol from 40mg to 30mg

 

Symptoms. 10 hours sleep last night, glorious! Slight restlessness, probably at pre drug levels though and I am just assuming it's a bad sign. Tingly electric feeling is much less. High and energised feeling in extremities. Mild anxiety, mostly over whether I won't sleep and have a **** day tomorrow, but also about getting well again.

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kesh

This morning I spoke to my doctor. He says that the sleep disturbance/parasomnia is almost certainly caused by anxiety. He wants me to increase citalopram to 10mg. He also prescribed 30 more days of 2mg valium and 40mg propanalol. 

 

 

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Altostrata

Please don't change the propanolol dosage at the same time you're changing diazepam.

 

It sounds like you had some number of days of disturbed sleep after reducing diazepam. I'd be very careful about reducing it as you seem to have a great fear of sleeplessness.

 

Those withdrawal symptoms indicate the extent of your physiological dependence on diazepam. Please note that as you take lower doses, a decrease of 0.5mg becomes more precipitous -- your nervous system will notice it more. At 2.0mg, a decrease of 0.5mg is 25%. At 1.5mg, a decrease of 0.5mg is 33.3%. 

 

We recommend a 10% decrease calculated on the last dosage -- the absolute amounts of the decreases keep getting smaller, while the rate of decrease (slope) stays at 10%.

 

Please don't push this, a misstep could cause quite severe insomnia for a much longer time. We see this frequently. At least you have another month's prescription to taper.

 

As for the cause of your sleep problems, it's up to you to decide if your doctor is correct.  Stress and worry certainly can affect sleep. However, the probability that your doctor can interpret withdrawal symptoms, adverse effects of drugs, or paradoxical reactions is very low.

 

For stress and worry, particularly when they are keeping you from sleeping, we highly recommend learning how to meditate.

 

Easing your way into meditation for a stressed-out nervous system
 
Mindfulness and Acceptance
 
Good links for anxiety/worry

 

Please also read:

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Waking with panic or anxiety -- managing cortisol spikes

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

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kesh

I slept wonderfully last night.10 hours. The good night/bad night thing is fairly common with me, and I think the big 25% cut is reasonable when I was only on 2mg for three weeks prior to the cut and before that was benzo naive.

 

8 or 9 days into the cut and I am feeling zero anxiety. 

 

Further cuts will be more conservative. I know you need to be more careful as you get close to zero, and I will have been on the benzo longer.

 

Back on 40mg of propanalol though. 

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kesh

Perhaps I spoke too soon.

 

4 hours sleep and woke up with some akathisia. I managed to resist it for a while, staying lying down. It's more an inner restlessness, I do not need to pace, but I am close. The tiredness is perhaps winning the horrible fight in my body and brain. Holding on for the next window. 

 

Dose of meds yesterday and today will be as usual.

 

2.5mg citalopram in morning. 40mg propanalol spread throughout the day. 1.5mg diazepam before bed.

 

I hope to stabilise here then cut citalopram by 5 or 10%. Citalopram is probably the cause of the akathisia, and the akathisia is what I dread the most.

 

Acupuncture today, which on previous days has allowed rest during the treatment. 

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kesh

Today is proving terrible. Internal restlessness and doom typical of akathisia. Yesterday I felt fine, like 90% well, but for some reason that does not help. I keep thinking I will have akathisia forever.  Other times I think conventional medicine is correct and I just have to find the right dose of the right med, this is just my illness, not the meds, making me feel so terrible.

Edited by manymoretodays
took out a section

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kesh

So a window began at 4pm. And though the akathisia has passed, the fear of akathisia and the fear of insomnia are strong.

 

Acupuncture was very relaxing and I was dropping off only to be zapped awake again. My acupuncturist believes she can fix me, my mother (a therapist) believes therapeutic things can fix me, my doctor thinks meds can fix me. I wish I had any faith in getting well.

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Gridley

Kesh,

 

Claire Weekes was a doctor who did groundbreaking work in dealing with anxiety. With your "fear of..." symptom, it might be helpful to read some of her work about dealing with fear.

 

I can't pick up the link.  Google survivingantidepressants.org the claire weekes method of recovering from a sensitized nervous system

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kesh

The thing to fix is the akathisia. Akathisia being treated as an anxiety problem is a way to annoy akathisia sufferers, offering a sticking plaster to someone about to stabbed. But I know Claire Weekes' work.

 

Yesterday I slept great, had a window from akathisia, did normal stuff, hung out with friends. Was great.

 

Meds same as before.

 

Last night slept not great, maybe 3 or 4 hours. Woke up with akathisia. It really is the worst. Praying it passes, and eventually passes for ever.

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kesh

New symptoms today. Very loose stools and going often. Hot/cold feeling like flu. I suppose I could be ill, not everything is the meds.

 

Aka has diminished, maybe gone. Can concentrate enough to read. Left very tired by it as usual. 

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Altostrata

Good to hear that, kesh. It may help to remind yourself that many people who experience the waves and windows are frustrated because of the lack of predictability.

 

When you have bouts of disappointment, you will have to find the resources within yourself to stay calm and help yourself heal. Allowing yourself to spiral into doomy thoughts does not help. See

 

Non-drug techniques to cope with emotional symptoms

 

Dealing With Emotional Spirals

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kesh

Thanks alto. I am doing some meditation and mindfulness techniques. Will check out those links.

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Nikki74
18 hours ago, kesh said:

New symptoms today. Very loose stools and going often. Hot/cold feeling like flu. I suppose I could be ill, not everything is the meds.

 

Aka has diminished, maybe gone. Can concentrate enough to read. Left very tired by it as usual. 

Just checking in Kesh. Glad to here aka has diminished. 

 

I’ve had the flu like stuff and bathroom issues. Normally another wd thing for me but could be flu. 

 

Wishing you rest. 

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kesh

Thanks Nikki

 

Meds still held at 2.5mg citalopram in morning. 40mg propanalol spread throughout the day. 1.5mg diazepam before bed. Cigarettes as needed. Typically ten a day.

 

Slept well, maybe 8 hours. Took a while to get to sleep because of the jerks/rushes while dropping off. Woke up a bit anxious and depressed. No akathisia. I haven't had much depression until now, totally eclipsed by other symptoms like mad howling fear. Almost welcome it, it feels somehow stabilising. As usual, if someone promised me no more akathisia, I'd take this.

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manymoretodays
2 hours ago, kesh said:

I haven't had much depression until now, totally eclipsed by other symptoms like mad howling fear. Almost welcome it, it feels somehow stabilising. As usual, if someone promised me no more akathisia, I'd take this.

 

Well said.  I definitely remember rating the trade off of one symptom for another.  :huh:

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