# Withdrawals from Amitriptyline... wtf?



## A Sense of Purpose (May 8, 2011)

So im currently (unsuccessfuly) tapering off amitriptyline from a dose of 50mg, as i transfer from my neurologists care, over to a Psychiatrist.

I have my first appointment with my psych coming up this tuesday, and had planned as of 2 weeks ago that i'd taper off all meds so i'd be ready to start taking what ever the psych prescribes for my migraines/anx/depression.

I tapered from 50 to 25 quite easily. Just halved the pills etc and stayed on this 25 mg dose for about 1.5 weeks.

I then halved a half.... so taking a quart of a 50 mg tablet (so should be round 12.5mg for about 4-5 days. No symptoms or issues.

Recently after the 4-5 days taper on 12.5 i decided not to take any more, hoping that i had tapered successfuly.

Little did i know the waves of nausea that were to follow and extreme headaches. I have started the 12.5mg dose again and am going to try and taper to half in a week.

A) Does this sensitivity to a relatively low dose Tricyclic suggest that im going to get F....d on by pretty much any SSRI/SNRI i try?

I was under the impression that TCA's had relatively little to no discontinuation symptoms compared to ssris/snris.

B) apart from doing what i've already said, is there any other way to minimize the taper off? its nasty....


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## jim_morrison (Aug 17, 2008)

Sounds like cholinergic rebound syndrome.


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## Arisa1536 (Dec 8, 2009)

Yeah its most likely because this is your first antidepressant and your body is not used to it. When i withdrew from nortriptyline (amitriptyline's newer cousin so to speak) I did not notice too many bad side effectys because i had been on and off of SSRI medication like paxil and fluoxetine and had a bad experience with two months withdrawal from effexor XR

i did notice nausea and headaches for the first three days though so it sounds normal, although given your low dose, you could ask for something to combat these side effects
TCAs seem to be given for migraine/depression and fatigue but there are softer ones and amitriptyline is one of the older stronger ones with more harmful side effects


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## A Sense of Purpose (May 8, 2011)

Yeah i guess that makes a fair bit of sense.
Will talk to the doc about it and see what he recommends.
I really need to be functional now with my exams a 2 weeks away.
Probably not the best time to withdraw and switch meds


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## jim_morrison (Aug 17, 2008)

Basically meds with anticholinergic effects such as amitriptyline have strong anti-nauseant properties, and as such rapid withdrawal from them can induce nausea, vomiting, etc. So a slower taper is likely necessary.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Basically meds with anticholinergic effects such as amitriptyline have strong anti-nauseant properties, and as such rapid withdrawal from them can induce nausea, vomiting, etc. So a slower taper is likely necessary.


Ok thanks, its all making sense now why my neuro's had me on amitrip for so long.

I wonder if the psych is going to keep me on it for migraines, and add something in for the dep/anx.

What would be a likely additive? Can you add anything to amitrip?


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## jim_morrison (Aug 17, 2008)

A Sense of Purpose said:


> What would be a likely additive? Can you add anything to amitrip?


Yeah things can be added but caution is needed as certain SSRI's, etc, can inhibit liver enzymes which break down amitriptyline, which can be dangerous as it's toxic in overdose. 
But your pdoc will surely know what's safe to add to it if augmentation is necessary.


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## A Sense of Purpose (May 8, 2011)

Yeah Jim, im kind of hoping he will suggest something like Wellbutrin or another atypical that doesnt have the sexual side effects like ssris.
3 days now, fingers crossed


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## jim_morrison (Aug 17, 2008)

Did the neuro ever try you on nortripyline for the migraines? From what I know that's another tricyclic antidepressant which is sometimes used for this purpose. I assume there are other classes of med's besides tricyclics that could treat migraine though, if it's neccisery to get off.

Good luck at the pdoc mate


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Did the neuro ever try you on nortripyline for the migraines? From what I know that's another tricyclic antidepressant which is sometimes used for this purpose. I assume there are other classes of med's besides tricyclics that could treat migraine though, if it's neccisery to get off.
> 
> Good luck at the pdoc mate


I was under the impression that nortriptyline was almost the same as amitrip, but i could be wrong.

Anticonvulstants are also sometimes usefull for migraines. 
I tried Topiramate but i felt like i was in the clouds when i was on that.
Felt so disconnected from everything... even my own body. So i stopped that. It did however make my headaches non existant.
Tough decision, Be in pain or be completely wacked out

Ill ask though, see what he says


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## jim_morrison (Aug 17, 2008)

Did you try the triptans or beta blockers? from what I can see those are sometimes used too.


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## yelda (Jun 12, 2010)

12.5mg amitriptyline is a too low dose. go on with it.


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> Did you try the triptans or beta blockers? from what I can see those are sometimes used too.


yeah Jim ive tried Inderal for a while, didnt seem to work.

I also tried Sumatriptan for abortive purposes of migraines, but it does nothing for the chronic daily headache.

Every day is seriously a pain.... its wearing me down a bit mentall (hence the psych appointment). Thanks for suggestions though.

Yelda, im on 12.5 for weening off the med purposes. I was on 50-75mg when i was using it for migraine prophylaxis


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## A Sense of Purpose (May 8, 2011)

jim_morrison said:


> I assume there are other classes of med's besides tricyclics that could treat migraine though, if it's neccisery to get off.
> 
> Good luck at the pdoc mate


It just recently came to me that when the headache peaks.... if i have a coffee or some caffiene early enough, sometimes it reduces the severity of the headache and i get some relief. (this could be coincidental however.)

Im thinking that they may be vascular related, hence why Roaccutane was able to induce them in the first place.

Perhaps a low dose amphetamine / stimulant would give me relief? Constrict the blood vessels (similar to caffiene's action) and stop the dilation of vessels and thus, the pain?

Something i will definately ask the pdoc about.


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