203 replies to this topic

[Troypants]

Yeh definitely not going to cold Turkey off either of them. Bisoprolol only 2.5mg so shouldn't be too bad.

BP is usually around 130/70 now so its not too bad

[Troypants]

Merry christmas to all!

[fishinghat]

Merry Christmas to you as well Troy.

 

May all have a Merry Christmas and a happy New Year.

[invalidusername]

Hi Troy,

 

My apologies for the delay writing back to you. This time of year is very busy for my business and I have very little free time.. if any.

 

I think the problem with social anxiety is that every time I go out I get punished rather than rewarded for social interaction. Its like being punched in the face every time I see people, just makes me want to stay home. I wonder how good it is for me?

 

This will seem to be the reaction initially. The problem with curing from anxiety is that the process is a very slow one. It takes time to see the benefits. From the very beginning it is a case of self compassion and seeing how well you have done to have simply done the task at hand - regardless of what you feel. You went to the meeting, you had that cup of coffee with a friend... that is all you need to consider. The fact that you use the word punished tells me that you are in some way blaming yourself or expecting yourself to react quicker. You will see the benefits, but they need time. I have always suggested the work of Dr Claire Weekes. She did some fantastic work in this field and certainly played a very important part in my recovery.

 

I have Christmas coming up and I don't feel like going, do you think benzodiazepines would help with the day or will they go paradoxical? I have some research benzos, flualprazolam and etizolam which I could take if needed but I am afraid of having a paradoxical reaction and making my day realllllly unmanageable.

 

I think Hat covered this well given your other medication, but one thing to really consider is alcohol and benzos. They don't mix!! So wherever you are currently with these drugs, just be well aware of this easy trap to fall into.

 

Wishing you a very Merry Christmas. Take care and remember to treat yourself as you would a friend going through the same circumstances. Love yourself and give yourself time - you will overcome this.

 

IUN

[Troypants]

Hey IUN,

I don't normally use benzos because I can't be bothered going through another withdrawal but I do have them there just in case. I think the last time I took on was 8 months+ ago.

Could you recommend me a book to read from Claire Weekes which would help me with my situation?

Thanks again IUN and Hat.

[fishinghat]

There are some books by Claire Weekes that other members have found helpful listed in the ebook.

[invalidusername]

Claire Weekes wrote 5 books during her practise, but it all began with "Self help for your Nerves". Another author, Paul David re-wrote her way methods for the "21st century" in a book called "At last a life". Some might find this easier to read. I can send you some links - and if you are a user of ebooks, then I can help you there. 

 

Drop me a PM and we can get you sorted out and on the road to recovery!!

[Troypants]

PM sent

[invalidusername]

PM sent

 

Replied

[Troypants]

I might start a bisoprolol taper tomorrow, what does everyone think?

My cardio said I can stop them but I haven't had the guts yet. I'm only on 2.5mg.

According to what I've seen you can do a 2 step taper over 1 week, dropping to 1.25mg for a week, then off. I was thinking of going for 2 weeks on the 1.25mg.

What does everyone think? I want to come off now because my heart rate is like 40 over night and I have read that b blockers can cause strokes and other side effects.

[fishinghat]

Your dr is correct. I have tapered of a beta blocker twice and a 2 week taper has always worked well. It is not a true withdrawal but is considered a "rebound effect". Stopping them cold turkey causes a sharp increase in blood pressure. A two week taper allows your body to adjust.

[invalidusername]

Yes for sure not one to do cold turkey. I had a PRN prescription but ended up taking for around 6 weeks more or less daily - even then I chose to taper. If it is something I have learnt more than anything, is that there is no harm in a taper provided it isn't an emergency. I can see how the pulse could be alarming - just keep an eye out for the usual symptoms.

[Troypants]

Awesome thanks guys, yeah I will taper pretty much anything now haha. It just makes sense.

Have been pretty well over Christmas, just trying to keep my stress down. Spent some time with family out camping and it wasn't even torture for the most part. When we got home I was a bit tired and felt like shit but its only lasted a couple of days. Although I had one of those prolonged brain zap type events where I feel like my consciousness zaps out briefly when I laid my head down last night, and my ears are ringing a little.

But overall I am feeling much better and life is becoming bearable and almost enjoyable for the most part. I'm yet to challenge myself and go out with friends etc but that will come.

[fishinghat]

Fantastic, slow but steady wins the race!!!!

[invalidusername]

Wonderful to hear that Troy - and well done for having the courage to go the distance with this stuff.

 

As Hat said, slow and steady, so keep at a pace you can maintain. 

[Troypants]

Is it normal to still have heart palpitations 8-9months since last drop?

It was happening before I lowered my beta blocker dose to 1.25mg so its not that.

[fishinghat]

I am not surprised.  I have seen this in many members who haven't made a drop in 8 to 9 months and with the subsequent drop in beta-blocker it would extend that symptom. One of the important concepts in much of medical practice to change only one thing at a time. Once a person is subject to 2, 3 or more changes in a relatively short time it is literally impossible to determine which change caused which change in symptoms. We have found that members who have stayed with one issue at a time (such as a withdrawal from a single med) usually takes longer but has far less issues in dealing with health-related issues.  Many of us see our best results with a 2 or 3 year wean from a given medication. This gives us a chance to have far less withdrawal symptoms and a much better chance of success without the use of additional meds to help. I know that patience can be difficult (it was for me also) but why suffer more than necessary. It is a personal choice of course and you can and will make it through this in time.

[Troypants]

Thanks fishinghat, it has been quite an extended wean from the cymbalta already, coming from 120mg down to 2.5mg, but yeah, I am not rushing it although I would love to be on the other side of it already. My last drop was quite fast which is why I am still feeling it. I dropped from 10mg to 2.5mg in like 2-3 months, not realising I should be dropping much slower.

I would normally drop 1 thing at a time but it seems that beta blockers aren't too bad to come off, and I was worried about the low heart rate. It hasn't been bad on the 1.25mg I was just wondering if it is normal to still have palps.

I get why we only drop 1 thing at a time though, small physical phenomena can be alarming when you're not at a comfortable homeostasis, and the mind races.

[fishinghat]

As long as you are having any withdrawal symptoms the palpitations do not surprise me, especially if you have been dropping dose on the beta-blocker recently. It should pass. 

 

"...small physical phenomena can be alarming when you're not at a comfortable homeostasis, and the mind races."

Well said.

[invalidusername]

Hi Troy.

 

The palpitations are no question a result of the beta blocker, not the Cymbalta. Classic symptom, and as Hat said, it should indeed pass in time.

 

It may come as a surprise at how many members we have had that drop at this low rate, yet still report issues. Obviously this is subjective, but happens a lot more than one would think. It is just a shame that you are one of these statistics. 

 

IUN

[Troypants]

What's annoying me at the moment, I'm not sure if I should push myself to socialise more or not. I don't know if its mostly due to not getting out enough, or more because my brain hasn't healed yet.

I am going to a psychologist monthly now, and I go out doing flyer drops every week for an organisation which is kind of easing me back out there. I guess I'll see how I go with these things. If it gets easier, then I know I can push a bit further and do some personal meetings where there is conversation and closeness and eye contact.

What do you guys think?

[fishinghat]

My basic philosophy is to not to "push" yourself at all as it only slows healing. The more stress you are under the longer it seems to take to recover. 

[Troypants]

OK well, I'll just continue with what I'm doing now and when I get comfortable with it I can think about doing other things.

Do you think it will just happen without me forcing myself? Like when I'm ready I will just end up doing these things?

[fishinghat]

"Like when I'm ready I will just end up doing these things?"

 

Exactly. Your body will tell you when you are ready. The thought of doing something will not bring on worries about 'should I or shouldn't I'. Trying to force yourself just puts more pressure and stress on you and makes the withdrawal just that much worse. Just let it come naturally. It took me 3 or 4 years to really feel comfortable doing all the normal things in life after my withdrawal.

[Troypants]

Isn't it a good idea to expose yourself to anxiety so you can learn to deal with it though? And desensitize? Or is it a bit early to be thinking about that?

Shit, sitting at the dinner table with my rents feels like I'm exposing myself go anxiety...

[fishinghat]

Unluckily exposing yourself to anxiety does not desensitize yourself. Anxiety (fight or flight) has been linked to a condition response called 'chronic adrenergic state'. This is where a person who is repeatedly exposed to a set stress will develop a heightened reaction to that stress which will remain for a long time. I don't know if you are familiar with the 'Pavlov's Dog' experiment or not but it goes like this. Scientist Pavlov rang a bell every time he feed his dog. After a couple weeks the dog immediately started drolling every time the bell rang. After this he would then ring the bell and NOT feed the dog. Each time the dog would automatically start drolling. It took months and months for the dog to recover from this conditioning. The same pattern exists in humans for adrenaline, the key compound involved in anxiety. Think of the soldier who during war are exposed to constant bombing. Every time a bomb lands the soldier immediately feels fear, anxiety etc. After coming back home from the war, even with therapy it can take years for the soldier to even slightly recover to the instant fear he experiences when exposed to a loud noise.

 

Pavlov's dog experiments played a critical role in the discovery of one of the most important concepts in psychology: conditioned response. While it happened quite by accident, Pavlov's famous experiments had a major impact on our understanding of how learning takes place as well as the development of the school of behavioral psychology. Classical conditioning is sometimes called Pavlovian conditioning. 

[Troypants]

Isn't another problem the avoidance? So if you keep running when you feel anxiety you confirm there is a real threat and condition yourself into having bad anxiety around that event.

Yet, if you sit with that anxiety until it passes (when there is no real threat), you condition yourself to sit with the relaxation rather than the false anxiety.

Am I hitting the mark here or?

Its a complex topic

[fishinghat]

Avoiding stressful situations during withdrawal is a long-standing technique applied by psychologists and the positive effects are well documented. One thing you must understand is that this is a chemical process. Stress causes a change in neurotransmitters. Mainly adrenaline but also serotonin and histamines.  Once these neurotransmitters have been produced at a higher concentration consistently during long-term stress (such as withdrawal) then the body becomes efficient at producing them. Once the stress stops the body must re-learn to control this production of neurotransmitters. This is very difficult with adrenaline. Most organs of the body have a sympathetic nerve going to the organ telling it what to do and a parasympathetic nerve going back to the brain providing feedback on what is happening in the organ. The adrenaline gland is the only organ that I know of in the body that does not have a parasympathetic nerve running back to the brain to provide feedback. Therefore, the body tries to adjust be trial and error. This is what causes the wild mood swings during withdrawal. On average (varies a lot though) it takes around 2 years for the body to restabilize serotonin and histamines after stress BUT, as one dr once told me, it can take many years for the body to relearn how to control adrenaline. The more stress during this time the longer it takes to stabilize. 

 

This is a chemical reaction and you can not think it away or mentally control the reaction. As your body slowly recovers it will slowly accept more activities as non-stressful. You may always have some sensitivity to stress and anxiety but with time you can adjust a great deal. This is where a good therapist who understands cognitive behavioral therapy or mindfulness can help you deal with things in the meanwhile. They teach techniques that help you minimize the effects of stress during the healing process. These help you get back to a more productive life more rapidly.

[Troypants]

So the adrenal gland is stimulated via ACTH to produce catecholamines, and stimulated via the splanchnic nerve with acetylcholine. There is a study showing alpha2 receptors can have some negative feedback too BTW.

https://pubmed.ncbi....h.gov/12764077/

But, most of the organs have both afferent and efferent para and sympathetic nerves, except the adrenal gland, which only has the sympathetic nerve. Hence, negative feedback must rely on endocrine negative feedback via adrenaline and cortisol. Which leads to a bit of a delay in the feedback.

Serotonin acts on the amygdala to reduce fear, and, assumedly, norepinephrine acts on the hypothalamus to control release of acth and downstream activation of acetyl choline mediated release of adrenaline.

So SNRIs really fk up the HPA in other words.

Does this sound right?

Have you got any studies showing how long it takes to stabilise serotonin, and adrenaline?

[Troypants]

My auntie is a nurse and she changes the subject when I talk about how long SSRIs take to come off. I don't think she believes me, probably thinks "i need them", doctors and nurses really need some training on addiction and homeostasis because they are just clueless to any of it. I never needed the bloody things before, I was just out of whack because I used to take recreational drugs, I just needed some time to come back to homeostasis.

And it makes sense, what kind of doctor would put you on a medication that does nothing for you, but throws your system out of balance and makes you dependent on it. The pharma companies can't have them knowing that.