Mysterious medication symptoms

[Jojomoon]

Hi everyone

I'm currently under the crisis team as my anxiety/depression became so bad I felt I urgently needed to end my life.

This was after a year of trying various medications and therapies, feeling like nothing was really helping me.

I'm currently 3 weeks into taking dulozetine at 60mg. I am experiencing the same symptoms I always have when taking antidepressants: feeling of being extremely cold, shivery and sore throat. It feels like I'm coming down with a cold/flu but it never goes away and is making me feel hopeless because all I want to do is stay in bed. This happened when I took sertraline and venlafaxine too so I know it is a side effect.

I have spoken to my psychiatrist and he cannot give any explanation for this and said it is very unusual to get flu like symptoms when taking antidepressants.

Can anyone explain why this keeps happening to me? It is making me want to quit taking medication again and that never ends well. I feel stuck between feeling mentally bad or physically ill on medication.

Please help or advise what you would do in my situation xxxx

[panic_down_under]

Hi everyone

to NMP,

This was after a year of trying various medications and therapies, feeling like nothing was really helping me.

Do you remember which meds were tried, how long you took them and at what dose? Also are you taking any other medications or remedies?

I'm currently 3 weeks into taking dulozetine at 60mg. I am experiencing the same symptoms I always have when taking antidepressants: feeling of being extremely cold, shivery and sore throat. It feels like I'm coming down with a cold/flu but it never goes away and is making me feel hopeless because all I want to do is stay in bed. This happened when I took sertraline and venlafaxine too so I know it is a side effect.

Feeling cold and shivery are not rare initial side-effects of serotonergic antidepressants (ADs). Serotonin is not just a brain neurotransmitter, in fact that's one of its lesser roles with less than 2% occurring in the brain. It has many other functions including in the regulation of blood vessel tone, constriction and dilation, and the heightened serotonin activity when first taking ADs can affect this. Some feel hot and with burning sensations of the skin (it uses about as much serotonin as the brain) and others feel cold. Pharyngolaryngeal pain, inflammation of the throat, is a potential side-effect of many medications, including ADs. It occurs in up to 10% of those taking duloxetine. In most cases all these side-effects diminish after a few weeks as bio-feedback mechanisms kick-in and serotonin synthesis and expression falls back to baseline, or well below it, however, they can linger for some.

I have spoken to my psychiatrist and he cannot give any explanation for this and said it is very unusual to get flu like symptoms when taking antidepressants.

Please help or advise what you would do in my situation xxxx

You may do better on an AD with a weaker affinity for binding to serotonin transporters. I see you have tried venlafaxine which is the weakest SSRI/SNRI reuptake inhibitor. How long did you take it and at what doses?

[Jojomoon]

Thank you so much for replying.

I'll write a list of everything i have tried so far.

Sertraline 100mg for 4 years, this really helped but eventually stopped working. I have since tried to start it again and had terrible suicidal thoughts.

Escitalopram 10mg helped but made me very sleepy and apathetic.

Venlafaxine 75mg for 8 weeks. This caused the same flu symptoms for the duration of taking it.

Duloxetine 60mg for 3 weeks, it is helping the anxiety but makes me feel physically ill.

I feel terrible because I've been signed off work for the past 4 weeks, I'm not getting any better and there is so much pressure for me to be back next week.

I feel like I've let everyone down and don't know whether to continue with this drug, hoping it will work or ask to switch to something else.

Being unmedicated isn't really an option because my mental illness is life threatening. But I want to be at the point where I'm well and functioning, not just lying in bed all day shivering and sleeping. It's getting to the point I wish I had just taken my life.

Anyway thank you so much for replying. I feel like things are hopeless from here. The crisis team have done some blood tests to check whether something physical is going on. I know when I was taking sertraline it reduced my white blood cell count, maybe something similar is happening with duloxetine.

I'm starting to think im so weak for even asking for help and I feel like I've wasted everyone's time.

Thanks xxx

[panic_down_under]

Sertraline 100mg for 4 years, this really helped but eventually stopped working. I have since tried to start it again and had terrible suicidal thoughts.

Escitalopram 10mg helped but made me very sleepy and apathetic.

Did you have the 'flu' symptoms with either?

Venlafaxine 75mg for 8 weeks. This caused the same flu symptoms for the duration of taking it.

Side-effects aside, was it effective at 75mg? And was any thought given to raising the dose? 75mg is the usual start dose for depression. Most need 150mg plus to get a good result and it only begins to function as a SNRI at doses of around 225mg and up, albeit still only weakly (despite the claims venlafaxine is really only a SSRI, with several SSRIs having a greater effect on noradrenaline, aka norepinephrine reuptake).

Duloxetine 60mg for 3 weeks, it is helping the anxiety but makes me feel physically ill.

Unfortunately, I don't know of any way of easing these symptoms, but your GP may.

I feel like I've let everyone down and don't know whether to continue with this drug, hoping it will work or ask to switch to something else.

Unfortunately, switching to another med may put you back to almost square one so sticking with it will give the quickest result...assuming it works.

Being unmedicated isn't really an option because my mental illness is life threatening. But I want to be at the point where I'm well and functioning, not just lying in bed all day shivering and sleeping. It's getting to the point I wish I had just taken my life.

You don't solve short term problems with permanent 'solutions'!

I feel like things are hopeless from here.

It is a long way from hopeless. It only becomes hopeless if you give up.

when I was taking sertraline it reduced my white blood cell count, maybe something similar is happening with duloxetine.

Duloxetine usually increases white cell counts a little.

I'm starting to think im so weak for even asking for help and I feel like I've wasted everyone's time.

Would you feel weak for asking for help with say type 1 diabetes, or rheumatoid arthritis? Anxiety disorders and depression are the emotional expressions of atrophy of parts of the two hippocampal regions of the brain caused by high stress hormone levels killing brain cells and inhibiting the growth of new ones. It is a type of auto-immune disorder which is why the symptoms often become more severe when the immune system is in overdrive fighting infections. Both therapy and antidepressants work by stimulating the growth of new hippocampal brain cells. The cells and the connections they form produce the therapeutic effect, not the treatments directly.

[Jojomoon]

Thank you again for taking the time to reply and research some of my concerns about side effects. It seems you know more about it than the crisis team! Nobody ever told me about serotonin making u feel cold, can I ask where you read this as it's reassuring me a little that I'm not going mad or making it up.

I agree I have to continue taking the medication. I have been on it 3 weeks so it really isn't enough time, but I'm getting so impatient with myself. I do have health anxiety and so when the psychiatrist said I am having 'unusual' side effects I immediately freaked out.

I wrote down the pros and cons of taking it so far:

Pros
1. No more physical anxiety or panic attacks.
2. Life seems less menacing
3. Appetite OK

Cons

1.flu like symptoms: shivery, freezing cold, sore throat, and fatigue since starting it.
2. Still feel depressed, low in motivation and energy
3. having anxious thought loops

The crisis team advise I keep going with it, I guess I have to listen to them because my anxiety and depression is really bad. But part of me still thinks I should've just gone to talking therapy and somehow cured myself without medication. However, I know it isn't true as they have said I'm not even stable enough to access talking therapy yet.


Thanks again, I'll keep posting updates, it's a rocky road and I feel so defeated and alone.

[Piano]

Maybe you have the flu? Anyways, I allways feel awful the first 8 weeks of starting an antidepressant. Also flu-like symptoms and spending time in bed. At 8 weeks they start working for me. Hang in there, you will get through this.


Sent from my iPhone using Tapatalk

[Jojomoon]

Maybe you have the flu? Anyways, I allways feel awful the first 8 weeks of starting an antidepressant. Also flu-like symptoms and spending time in bed. At 8 weeks they start working for me. Hang in there, you will get through this.


Sent from my iPhone using Tapatalk

Thank you piano xxx

[panic_down_under]

Nobody ever told me about serotonin making u feel cold, can I ask where you read this as it's reassuring me a little that I'm not going mad or making it up.

Feeling cold, or, more often, hot, are fairly common initial side-effect of most SSRIs and SNRIs, including duloxetine. You can find lists of AD side-effects online by googling the name of the med + side-effects. I usually use www.drugs.com, it's duloxetine list is at https://www.drugs.com/sfx/duloxetine-side-effects.html under "Other". However, I suggest that these lists not be read as they all to often ensure readers with anxiety disorders begin developing most of the symptoms. Anxious minds are very adept at creating our worst nightmares if given half a chance.

Serotonin's effect on blood vessel tone is well known, google: serotonin+"blood vessel tone"

Serotonin is also a critical component for stemming blood loss and healing wounds after injury. Most of the body's serotonin is stored in blood platelets.

I agree I have to continue taking the medication. I have been on it 3 weeks so it really isn't enough time,

While some report a response within 2-3 weeks this usually owes more to the placebo effect than pharmacology for it takes about 7 weeks for brain cells to bud, grow and mature, though some improvement may occur earlier.

2. Still feel depressed, low in motivation and energy

SSRIs/SNRIs tend to be more effective anti anxiety than anti depression meds and many find anxiety lifts several weeks before their depression does.

But part of me still thinks I should've just gone to talking therapy and somehow cured myself without medication. However, I know it isn't true as they have said I'm not even stable enough to access talking therapy yet.

The cognitive, behavioural (CBT, REBT, etc) and mindfulness therapies can be at least as effective as ADs and should be considered once you've stabilized. ADs plus therapy is often more effective than each alone.

it's a rocky road and I feel so defeated and alone.

They say it's always darkest just before the dawn. You'll be fine. You just need to give the med time to weave its 'magic'.