Amitriptyline

[angels22165]

Merry Christmas

Sorry to post this on the GAD board but I see not many people use Amitriptyline anymore And thought may reach people better on here.

I started Amitriptyline be 3 week on Monday 50mg at night the initial side effects of grogginess day after seem to of wore off - last few days my anxiety been sky high - just do not feel normal, so on edge, breathing feels funny, heart thumps - went to see locum GP yesterday and he has told me to take one or two 10mg twice a day along side my 50mg at night - I have an assessment in two weeks so really trying to hold on until then - I took a 10mg at 10 this morning made me feel tight chested and like more effort to breathe but head wise did seem a bit calmer, now it's 2 and can feel more anxiety again - just feel don't know what to do for the best If anyone is on Amitriptyline is the tight chest normal and did you benefit from then. Thanks Julie

[pulisa]

Julie, these anxiety symptoms could well be from venlafaxine withdrawal. The dose of amitryptiline is very low and can't equate to your former dose of ven. These are just my personal views having had experience of ven withdrawal and its very protracted effects on the nervous system.

[angels22165]

Do you think Pulisa even after a month of not being on them now, just spoke to pharmacist and he said could be a mixture of both anxiety and the Amitriptyline - I don't know whether to take the extra Amitriptyline now during the day or just keep to the one at night and keep telling myself it's only the anxiety and wait until I have the assessment In two weeks, just feels so hard at the moment.

[pulisa]

I'm not a doctor obviously but I don't think it's unreasonable to think that the ven cold turkey plus substitution with a non-therapeutic dose for anxiety of amitriptyline is taking its toll?

I think you need to see your GP as soon as you can after Christmas. If he's going to prescribe amitriptyline for you then you need some clear guidelines for a therapeutic dose for anxiety/depression.

I'm really sorry that you are in distress, Julie and I hope you get some positive help really soon from the professionals

[SADnomore]

Oh, my. Sorry, honey. ... I do believe Pulisa is right on all counts, and if you must wait for two additional weeks to be seen again, then the daytime increase may actually help with your anxiety. I agree with Pulisa that you need more in your system, and quickly, if you are to start feeling better soon!

Good luck xx
Marie

[angels22165]

I can ring the GP on Tuesday to ask for a set dose as the locum doctor just said 1 or 2 10mg twice a day along with the 50mg at night which feels trial and error to me and unsure what to take as didnt think they worked instantly like a benzo, the apt in 2 weeks is with the local mental health team, so hopefully then can get somewhere.
I took just one 10mg yesterday and then the 50mg at night did stuggle but managed to cook the dinner ok.

Feel on edge this morning so may just try with another 10mg and take it from there.

Do you think people can actually manage on lower dosages of a different med to the one they was on previously and get by with positive thinking - I'm trying my best too :-)

[pulisa]

You were on a high dose of venlafaxine and have been switched to a non-therapeutic dose for anxiety of amitriptyline. I think anyone would be struggling to adjust even the most positive thinker? The strength of your anxiety breakthrough symptoms illustrates this.

Maybe being aware of this makes your symptoms more logical though and this may help you to accept them?

[angels22165]

Hi Pulisa

When I went to see the GP just over a week ago informing him of the anxiety symptoms I was having now the Amitriptyline initial side effects had worn off, he didn't once say increase anymore just that he was referring me to the mental health team. Unsure why he didn't want to increase. But Christmas Eve was just to unbearable so the locum GP who does work in the same building just runs a different surgery said to add more to help the anxiety.

I get what your saying about the difference in strength of meds and it does make sense - that's what I trying to do just keep telling myself it's only anxiety even though feel so rubbish.

I took another 10mg which makes me feel bit weird - head feels numb but all symptoms still there like it dulls me slightly being aware of them, apart from the heart keep thudding irregular now and again and chest tightness.

I've had GAD for 22 years and think this is the worst acute anxiety episode been through with all the messing of the switch from ven just wish now I had dealt with the anxiety better when was on 150 before he upped that and started with the itching - nightmare to see the least

[pulisa]

I think your GP made the wrong move to take you off ven. You could have reduced to 150mg to see whether the itching was related to the ven increase to 225 or whether it was totally unrelated and a red herring.

It's a good thing that you've been referred to the mental health team as otherwise I'd advise you to see a different GP.

Have you got any diazepam left to tide you over until Tuesday when your surgery opens? I know it's not the answer but in the every short term it will dull down the anxiety symptoms which are distressing you

[angels22165]

Yea I have about 5 2mg of diazepam left, do you think they be okay to take with the Amitriptyline - would you not bother Pulisa taking the Amitriptyline during the day if it was you?

[pulisa]

Personally I wouldn't bother with the added amitrip as it's not really enough to do anything therapeutic. However this would just be my choice and you've consulted a doctor who has told you to take the additional ami so it would be wrong of me to tell you not to.

Can you get some advice about possibly taking some diazepam?

[angels22165]

Yea I could ring a pharmacy if it gets really out of control and ask them if could take It along side Amitriptyline. If I took the 50mg at night and two 10mgs during the day I think that is the therapeutic dosage start of this med Pulisa.

[pulisa]

It used to be 75mg when I first had it but that was about 20 years ago! I remember cutting it in half because I didn't like the sedating effect and the GP said that I would get all the side effects without the therapeutic value of the drug. I ended up taking 150mg but it didn't help me (same old story re meds)

Ami is associated with potential cardiac problems so I expect that dosages have been modified now to reflect this.

[MyNameIsTerry]

Julie,

Just a quick post from me as I'm only passing through until later but I wanted to reassure you whilst there is a Moderate drug interaction between these two meds, the warning is identical to mine and my GP had no issue prescribing them together to get me through the start up side effects.

The possible side effects are more dizziness, groggy feelings, etc which are common to Diazepam anyway and tells me it's not about your other med as much.

So, if you can't take any more, don't be afraid to use them. I did the last 2 days of the worst side effects when starting Duloxetine and it did help to have some respite for a couple of the worst hours of the day.

[angels22165]

Took a second Amitriptyline at 3 as thought stick with the locum GP advise, 50 minutes later - never experienced such a wired feeling of intense anxiety including chest pain SOB and tight chest, contacted 111 for advise and they called an ambulance, just got home now after heart checks, I'm okay heart wise but the consultant did tell me just to stick with the one at bedtime and contact the mental health on Tuesday to inform them what as happened with the meds and need to be seen before My apt on 8th to sort a new medication out - he was very nice and apologised there was nothing he could do in the A&E dept - so will keep positive on the 50mg and wait until Tuesday and if need to take the 2mg in the meantime.

The consultant was going to give me diazepam but he said the 50mg of Amitriptyline as enough sedating properties.

The anxiety got so bad feel frozen and the least bit of task or chore or even walking up the stairs triggered a panic attack

Thanks for replying everyone x

[pulisa]

I'm afraid intense anxiety can produce these symptoms. I'm really sorry you have had this frightening experience but you've now been checked over and have been given definitive advice. Contact the mental health team on Tuesday-you need to speak to someone who has expert knowledge re prescribing these meds. Your GP would only fob you off again.

[angels22165]

Thank-you Pulisa for keep messaging me through this I'm very grateful :)

[pulisa]

I'm sorry that I can't be of more help. I'm very used to your symptoms-they are horribly frightening and can scare the living daylights out of you. I've had decades of this but can still feel poleaxed whilst in the midst of a bad spell.

I hope you can get a good night's sleep after your ordeal today...My advice would be to ring the mental health team as soon as possible after it opens again on Tues. They are going to be really busy after the holidays so try to get your call in before everyone else? The fact that you have been sent to A&E by NHS111 may help to prioritise you as regards getting attention- I really hope so xx

[angels22165]

You been a great help Pulisa it's just nice to talk to someone who understands and been through the same. I'm meant to be in work Tuesday so hopefully they will understand and I will be on the phone to them first thing. I've just taken my night time Amitriptyline now was very hesitant to take, which I know is silly but hopefully will get a good nights sleep.

Thanks again Julie xx

[MyNameIsTerry]

I can remember that stage, being scared to go upstairs in your own home. It's something you can't imagine until you've been there.

Take things hour by hour, as pulisa said to another member today, and it's how I got myself through the hardest stages of starting meds. I would use the clock and TV schedule as a marker for how the day was passing and just let it go forward while I stuck it out.

It won't stay like this, Julie. :hugs:

[pulisa]

No it won't. You might feel like it will but it won't. I do hope you managed to get some decent sleep and that today is more manageable. Take it hour by hour xx

[angels22165]

Yes managed to get some sleep, woke up about 7 felt the anxiety straight away but distracted myself on my phone, had another hour, I think your right to take it hour by hour and just use distraction - the anxiety at the moment is just constantly here like on alert and feels least bit of thing I do will cause a full panic attack. Do you think this is because the meds aren't working as should be.

The consultant said to use the paper bag technique have you ever tried this - I've always used distraction

Like you say it won't be like this forever, I will just have to ride it out until I can get the meds changed and try and keep positive with distraction xx

[pulisa]

The paper bag breathing is ok for some as it is meant to help with breathing and hyperventilation. I think you would probably need a bit more help than that to say the least. If distraction works and you are able to concentrate sufficiently in order to distract yourself then go with that as much as you can. Trouble is there are a lot of minutes in the day to fill when you are really agitated...

My view is that your medication isn't helping and you are suffering from venlafaxine cold turkey withdrawal. Your GP won't "get" this (they never do) but a psychiatrist should have the expertise to sort out your meds and get you onto a drug or a combination of drugs to help ease the agitation.

Sometimes self-help techniques aren't enough. You've been let down by your GP and left to flounder. Once you see someone suitably qualified to help you you will be reassured and things will improve. You will also have back up and support from a professional team xx

[MyNameIsTerry]

You can use cupped hands as well as the paper bad. Unless you have that specific issue with panic, it's a worthless technique anyway. There are many such minor techniques to control symptoms quickly e.g. the dive reflex. They can help when you are really bad but only if they are meant to work on the specific symptom you have. So, do you hyperventilate?

The fact you have a positive attitude is one up on me when I was in that place. I hung on telling myself it couldn't last and I got through it. I never want to go to that place again so I know a bit about how you feel.

I think you also need to remember why you were increasing your Ven in the first place. I don't know about the withdrawal, I reckon it would hit quickly, but these meds are so individual and some people seem to suffer withdrawals longer than the chemical changes in the body are even lasting for so it's still an unknown science (just like how they don't even know how some of these meds actually work!). But I think it's likely to be your underlying and possibly already escalating anxiety on top of the withdrawal issue so it's going to be a really tough period.

We will try and help if we can, Julie, we remember going through it. You are not alone.

[SADnomore]

So sorry you are still struggling, hon. I am gutted that the extra tablets made you feel worse. I wish I could wave a wand and you would be at your appointment. Stick with us on here, and as Pulisa says, if you need to talk to a team, go ahead and call. That is a good distraction in and of itself, right? :)

What did you have for Christmas Dinner? If you have any leftovers, you might try using part of them as a base for a nice homemade soup! Put on a radio while you are chopping and tasting. Take your time and add bits and bobs from the fridge. :hugs:

[angels22165]

Hi just rang the mental health unit only the crisis team there today but did speak with a psych nurse, he told me to not take an amitriptyline tonight and ring back in the morning when all the teams are in and if feel worse anytime during day ring them
back.

My breathing just gets totally muddled Terry and feels like I don't have the air to speak and seem to gasp for breath and breathe deeper not sure if this is hyperventilation that lasts for a few mins upto 10.

Christmas and boxing day were nice had mi parents and both children there with there other half's, not much really left in fridge now but distraction is definately the key.
Woke this morning to the tingles again, palps and the feeling of on edge so going to get up and hopefully will ease.

[pulisa]

I'm glad you have made contact with the team, Julie. You need a specialised opinion as to what to do next re meds. Your symptoms are purely anxiety related-don't give them too much attention. If you can distract yourself this proves that you are not in an acute phase of agitation.

Tomorrow is nearly here now and you have done so well to get through these last few days. Ring the team as soon as you possibly can tomorrow morning? xx

I know I shouldn't say this but is it possible to change your GP? It always helps to have a GP who is reasonably clued up re mental health and appropriate meds. I know they are few and far between though.

[angels22165]

Cannot wait for tomorrow to come and hopefully get on the right road these last few days seem a Blair all rolled into one, my daughter is brilliant and is supportive but my husband just doesn't understand and doesn't talk about it apart from saying it's the meds what are doing all this to you - I don't get into it with him as just makes it worse - he thinks all meds are to blame.

I can distract myself with the feelings still there but they just don't seem as intense when I'm doing something.

There's only a few GP practices in my area and the main one with a few GP's there I work for, I think he is okay and has tried his best over the years and can always get seen on the day with him, but now realised that he can't do anymore that's why he has referred me - think with closely now being under the mental health team things should hopefully start improving xxx

[MyNameIsTerry]

I think the paper bag is more to normalise breathing when you are over breathing. If they think it helps, give it a try, there is nothing to lose. But from what you describe it sounds more like just not breathing normally. It might help though as it will get you focussing on breathing normally.

I would suggest a calming breathing exercise. I always found a those stages these were difficult to keep going as they wore you out but they are worth trying.

If you are getting a lot of muscular tension, it can also knock onto this. As can posture. You might find it easier to breathe standing up or harder if your core is scrunched so have a look at that. For muscular tension though, Progressive Muscle Relaxation (PMR) is useful. It's an old technique from the 1920's but they still use it today. My therapist gave me a worksheet for it but there are loads on Google Images. I can post one, and a breathing exercise, if needed.

It's a really good sign that you can be distracted. That shows that you could try distraction techniques with some success. It's worth having a go.

[angels22165]

Thanks Terry, yea breathing exercises seem to make my anxiety worse, I think when I try to practice it makes me feel panicky and my breathing gets out of sorts then end up feeling worse, what is normal breathing resting in 2 out 2 and no rest in between. I used to be obsessed about my breathing about 15 years ago there wasn't a waking moment I didn't think of breathing, which made me very anxious, think that's why alot of the anxiety is still surrounded by the breathing.

Well rang mental health yesterday they couldn't bring my apt forward so it's still a week tomorrow, the nurse I spoke to was really nice and said if struggling ring the crisis team and go back to GP and get a short course of diazepam to take when needed - so GP yesterday he said I can up the amitriptyline to 70mg at night and give me a weeks course of diazepam.

I didn't take the 70mg last night just the 50mg - I'm now trying my best to hold onto next week, as I don't really want to increase again just incase the psychiatrist changes the meds next week - do you think this is the best move?

[pulisa]

Absolutely the best move. In all likelihood the psych will suggest another meds regime anyway and you'll only have more amitrip to withdraw from.

I had exactly the same problems with the obsession with breathing. Any mention of breathing exercises makes me panic:D

[angels22165]

Its awful isn't it and then when your breathing is faster due to the anxiety it makes it even more a problem, what do you do to help yourself when you can feel panic coming on? I just use distraction anything so I'm not aware of how I am breathing, games on my phone help quite a bit.

Yea I thought so too with the Amitriptyline and it is only another week and surely it can't be worse than the week just had and now I have some Diazepam to use if feel really bad xx

[pulisa]

I can't distract myself when at my worst so I end up focussing on my breathing every second of the day which isn't funny and can last for ages. I haven't been in that position for a while but if I think about it I could easily get back into that pattern.

Use the diazepam if you need it and use it before the panic gets too bad because it will work better if you nip things in the bud. I'm sure your medication will be changed xx

[MyNameIsTerry]

Yes, I found they very hard at first. In my head I was saying 'I don't want to focus on my breathing because I'm already doing that all the time!!!' but actually after doing it for weeks or months it did start to help more.

If you have worked your way out of that before, I can understand the worry but maybe testing it and stopping if the signs show up is a way? It's not ideal as it would be an avoidance but early on we can't exactly stop these and they can be helpful in the short term until we can tackle them properly.

[angels22165]

Tough day yesterday, work certainly did not help but got through it and now I'm on leave until week Monday so that will hopefully help alot. Spoke to GP yesterday as the panic level had been constantly high he has now told me to take 3 2mg diazepam everyday alongside the nightime Amitriptyline, feel like I'm in a constant nightmare at the moment, with the breathing, chest and diaphragm tightness, tingles and thoughts it's really getting me down. I'm also now trying not to worry myself being on the diazepam everyday it really does help squash the anxiety and tried so hard to distract myself without it but the anxiety seems to be winning at the moment xx

[pulisa]

In the short term diazepam is a godsend when all else fails and you need to feel like a functioning human. You won't get addicted-your dosage is still very small.

[angels22165]

Thanks Pulisa xx

[pulisa]

I think it's amazing and a credit to you that you have managed to continue to work. Am really glad that you have now got (I was nearly going to say some breathing space:D)a chance for some respite from the demands of work xx Keep taking it hour by hour and a day at a time

[angels22165]

I know not sure how I got through work myself the past two days felt many of times so Ill with the anxiety thought was going mad or faint but didn't so I think did okay, but yes sooo glad I'm off now

. Pulisa would you take the diazepam like he said 3 a day to keep me feeling at a easier state until my apt, or when needed, I've woke this morning with the anxiety but not as intense as yesterday and head slightly calmer but I did take a diazepam at 12pm and then 6pm and also the Amitriptyline at 7pm which probably why it's not as intense this morning, I know I shouldn't be worrying about the change of meds next week and should just take an hour at a time

Yes the breathing I don't seem as obsessed with it this morning, which must be down to the calming of the diazepam xxx

[pulisa]

I have always been advised to take diazepam throughout the day during crises and not "when needed" so as to avoid an anxiety build-up and to try and stabilise things. When I was in hospital I was on a large dose broken up throughout the day for a week and it really helped. I had no problems tapering off.

I think if you have been prescribed 3x2mg daily then it would be a good idea to see if this regime keeps your anxiety on a manageable and even keel until your appointment? It's only for a few days and then the psych will reassess the situation xx

[angels22165]

Thank-you yes best doing that, as I do seem to wait until it gets unbearable then takes longer to calm down with them xxx

[pulisa]

I think the best thing to do is take the diaz before the panic builds up too much. You are aiming to stabilise the anxiety not wait for it to spike

[angels22165]

So do you think taking 3 a day for next week until the apt then maybe few days after until new meds start working which I may get prescribed, I won't have a problem stopping the diazepam xx

[pulisa]

Only your psych will be able to advise you on this but in my opinion you wouldn't. I'm only a fellow sufferer though and speaking from my own experience of having a week's worth of high dosage diazepam whilst in hospital. You must of course take the advice of your psych on this xx

[angels22165]

Thanks Pulisa I will xxx