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Dr. Bob is Robert Hsiung, MD,
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Posted by Julia on September 18, 2000, at 4:39:34
I had been on dothiepin(tricyclic antidepressant used in the UK) for 3 years,mainly for chronic fatigue and a bit of anxiety.The fatigue has got worse and i stopped responding very well to the dothiepin,so I stopped it 3 weeks ago.Since then my brain has become a bit clearer and I am sleeping a bit better,but I am feeling very anxious and weepy,and worsening fatigue:also some myoclonic jerks,and over the last week I have had some nausea.I have never felt this depressed or anxious before:is this still withdrawal symptoms or a depressive episode-I am thinking of startin an SSRI to cope ,but don't want to do this if
these feelings will pass Any comments?
Posted by JohnL on September 19, 2000, at 4:51:09
In reply to tricyclic withdrawal, posted by Julia on September 18, 2000, at 4:39:34
> I had been on dothiepin(tricyclic antidepressant used in the UK) for 3 years,mainly for chronic fatigue and a bit of anxiety.The fatigue has got worse and i stopped responding very well to the dothiepin,so I stopped it 3 weeks ago.Since then my brain has become a bit clearer and I am sleeping a bit better,but I am feeling very anxious and weepy,and worsening fatigue:also some myoclonic jerks,and over the last week I have had some nausea.I have never felt this depressed or anxious before:is this still withdrawal symptoms or a depressive episode-I am thinking of startin an SSRI to cope ,but don't want to do this if
> these feelings will pass Any comments?Julia,
It's hard to tell. My initial gut instinct though tells me that after being on any medication for 3 years, adjusting to its absence will take some time. I would guess in the 3 to 6 week time period. Feelings you may experience could span the map.
The anxiety and nausea sound like body adjustments to the absence of a medication it was accustomed to. But the depression, weepiness and fatique sounds like something more than that. I've been through plenty of these withdrawals. The longest was after one year of Paxil. But I also encountered similar symptoms as you when stopping the tricyclic Nortriptyline. My gut instinct tells me you are probably actually experiencing a mix of both withdrawals and the core symptoms you were originally treated for, all combined for a double whammy.The anxiety and nausea are a pain in the butt. Nuisance feelings. The fatigue is even more of a handicap. But the weepiness is serious. That's more than a nuisance. That's serious.
So what to do? Well, if you are tough as nails, you could ride it out for a few more weeks and see how it goes. But I think that is not a safe thing to do. Like I said, the weepiness scares me. I think it might be wise to consider restarting drug therapy of some kind. SSRIs could help your anxiety, but I doubt they will do anything for the fatigue and maybe just make it worse. I think no matter what you take, a stimulant of some sort will work very well and should be seriously considered as part of your overall therapy program. You would have to experiment with a few to see which works best for you. Personally I would start with Provigil. It is very anti-fatigue, quite anti-depressant, and doesn't create a roller coaster ride like some of the other stimulants. It's more mild and smooth. Headache is the primary side effect which goes away in a few days. Another medication for both anxiety and depression could include SSRIs, Serzone, Remeron, a different tricyclic, or a benzo.
In any case, it's hard to think of any one drug that will treat both anxiety and fatigue simultaneously. I mean, anything's possible, perhaps one drug could do all that for you. But I'm tempted to think you will need two medications working in synergy for each of the symptoms, with both working on depression too.
This might be an interesting eye-opener...try taking just one dose, or even one half-dose, of your previous medication. That could smooth things out just enough to buy a couple days of relief to gather your thoughts and think about it. Kind of like calling a time-out. Your body is probably craving Dothiepin at this point. No harm in relieving that temporarily. Sometimes taking sporadic doses here and there during withdrawal is a good way to smooth out the whole process. That has worked well for me a number of times. Withdrawing from a year on Paxil for example, I found taking just one-half of the minimum dose once every three or four days was just enough to smooth everything out nicely. After a couple weeks I realized I could make it through the fourth day without any Paxil at all. Same thing with the tricyclic Nortriptyline. On the third day of not taking any at all, I took a half-dose. That provided enough relief to get through another three days while my body continued to adjust. Soon I was done. Decades ago when I withdrew from illegal drugs, like marijuana, the same strategy worked well. All you need is just a tiny bit for a stepping stone every few days or so until you realize you can get by without the next stepping stone.
But again, I must say the weepiness scares me. Please view that symptom seriously.
John
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