182 replies to this topic

[fishinghat]

Well it has been a while since I posted about my situation. As many of you know I have been weaning off all the drugs that the drs had tried on me for my Cymbalta withdrawal that didn't work . I am on the last one Lorazepam. I have been using water titration at a slow rate with no withdrawal symptoms but it is very slow. SO, I took a chance. I made a list of those supplements that may help my Lorazepam withdrawal and ordered them in. I then increased my drop rate a little. That drop produced a rather constant grundgy feeling that was not pleasant but I could tolerate it. I then started testing the various supplements one at a time to determine if they will help. I will maintain this thread so you can all learn from my experience.

1st Test

500 mg of Vitamin C - I have a sensitivity to vitamin C because I have a history of a cardiac arrhythmia (paroxysmal atrial tachycardia). Constant use of Vitamin C can aggravate such conditions which it does in my case. So I decided to take it once a week, on Mondays to see if it will provide any relief. I have done this 3 times now and each time the symptoms were cut in half for about 3 hours. Not a cure but some help.

2nd Test

150 mg of Zantac - I took Zantac at around 4 PM on 4 straight days as symptoms were a little greater in the evening. Zantac is suppose to have an anxiolytic effect (anxiety fighting), I found a very slight improvement in my symptoms but not a lot.

3rd Test

1500 mg of Lions Mane mushroom - Lion's Mane mushroom is suppose to have a significant effect on anxiety. I started it yesterday and will use it 2 weeks and report back.

[invalidusername]

It only occurred to me last night that we are not always aware of how you are doing - and here is your update. I suppose with your knowledge and experience, there is little that us here on the forum can do to aid you as you will ultimately know what is best for you. These experiments look to be very interesting and I will be checking in to see how you get on with the lion's mane. I have seen that other members have used it previously, but there is very little written up about it therapeutic use.

 

Again, not much one can do except wish you all the best for your final part of the progress. I am very happy that you have got to this point in your recovery after such a struggle. 

 

Bless you, Hat.

 

p.s. you got my 1000th post here

[gail]

Fishinghat,

I'm happy to hear that you will post the results every time you have one.

What's left of the lorazepam and why have you chosen to increase the drop?

If I understand right, you will try each one for two weeks?

On that, we all thank you for being there for us. This should be a real interesting post to follow.

[fishinghat]

I am honored IIUN.

I will try each one for 2 weeks and then decide if I should add it to my meds or not. I started at 6 mg/day of lorazepam, a very high dose, and it did me no good at all. I have weaned down to the current 1.3 mg per day over a 4 year period. That way no withdrawal symptoms. Recently there has been a lot of research linking long term benzo use to dementia and I have heard (but not seen for myself) that the FDA has issued a black box warning for benzos and dementia. I decided it was time to pick up the pace a little.

[invalidusername]

Hmmm. These things are very worrying, and if you can stick out the quicker pace, I agree. A friend, now in his early 70's, was diagnosed with Parkinson's disease 4 years ago - this following around 15 years on similar meds to ourselves. Needless to say, they had to be stopped as they cannot be taken at the same time as the meds for the Parkinson's.

[fishinghat]

I fully understand that. Ahh, the wonder of growing older. NOT!!!!

[invalidusername]

or in my case... the wonder of feeling old, but not being old

[fishinghat]

Continue with Vitamin C and Zantac. Had to stop the Lion's mane mushroom on the 9th after 3 days. Nausea, diarrhea, etc. All of that is almost gone now. I will give myself a few days more and more on to Ashwagandha.

[invalidusername]

Did you notice any effect from the Lion's mane, or did the side effects cloud anything from it?

 

Have you used Ashwagandha previously? And you decided on dosage and brand?

[gail]

Following you Fishinghat, thanks for updating!

Are you feeling anxiety, if so to what degree?

[fishinghat]

IUN - I was only on the Lion's Mane for 3 says so I didn't notice any advantage. I had tried it once before for a different medical issue and had to stop it then also. At that time I was on it a little longer and felt me mental health effects at all.

I have not used Ashwagandha in the past. The brand I bought was FineVine with black pepper extract.

Gail - No anxiety. I only slightly increased my drop rate on the Lorazepam. Mostly is is a slightly agitated condition in the evening. Nothing I can't handle. I was thinking that this was a good opportunity to see if any of the supplements would provide a benefit to this withdrawal.

[invalidusername]

Had a look at the FineVine Ashwagandha - wow it is really cheap! $5 for 90 capsules!

 

Has some good reviews and it is root based, so no leaves. However it is not standardised, so whilst it is 1500mg, which is quite a dose, you will be getting a different potentcy in each capsule. Ideally you need to find a standardised product that states in withenoids. The KSM-66 that I mentioned before is by default standardised as it uses parts of the root known to be the most potent, and is on average 3 times more potent than standard extract Ashwagandha.

 

But see how this stuff goes and let me know. You should feel calm after a dose or two, but the long term effects can take 1-2 weeks. Bear in mind that most people find they need to up a dose after a couple of months of taking it every day. So some stop taking it the 4th week of 4 - or similar - to counteract this effect.

[fishinghat]

That is pretty much what I found as well. I appreciate your review. I noticed that this product has a warning about using it if you have a thyroid condition. It turns out that Ashwag… raises thyroid hormones t3 and t4 BUT the black pepper extract lowers t3 and t4. Due to the instability in the effect of these components there is a thyroid warning. As I an a recovering subclinical hypothyroid patient I will stay away from this supplement. I also found that the piperine (black pepper extract) allows the extra absorbtion of medication in the digestive tract and although extensive research has not been conducted there is a number of medications that it has already been demonstrated to significantly elevate during use. I certainly do not want to start jacking around with my medication absorbtion. For right now the Ashwag… is out.

[invalidusername]

Good coverage of the effects there - and just shows us all how careful we need to be with such things - not only medication.

 

Is a shame as it does have a good effect on most. I need to start considering something similar myself again to stabalise these continued withdrawal effects. The Apple Cider Vinegar worked well for the physical symptoms but did have a tendency to make me nauseous, even when I was sipping it throughout the day. I have not yet braved the Rhodiola Rosea as it has been shown to increase anxiety over prolonged periods, and it will be very difficult to determine what is causing what when I am still on this rollercoaster. 

[fishinghat]

Ok, I continue with 500 mg of vitamin C on Monday evenings and 150 mg of Zantac each evening. These definitely help but not a huge amount. I stopped the lion's mane after 3 days use because of stomach issues and it got better but since then the stomach issues have become routine. I suspect that this is a condition called "benzo belly" which I am familiar with from earlier experiences with a faster pace withdrawal. This means I may once again try Lion's mane at a later date but in the meantime I have started on 600 mg daily of NAC (N-acetylcysteine) a strong antioxidant. Too early to tell if it is helping.

[invalidusername]

Reading up on it, N-acetylcysteine is said to be used for pain killer overdose primarily! But also for the making of gluathione which is important for reducing the effects of oxidative stress and liver cell damage. What is your decision of N-ace over the Glu?

 

I remember zantac when I was younger - I had a bout of something strange in the stomach which would over produce acid. Did the trick, but I never knew what was wrong with me at the time. Clearly an old drug!!

[fishinghat]

NAC - N-acetylcysteine - Strong antioxidant.
It, like vitamin C, have been shown to be anxiety fighting supplement.

https://www.ncbi.nlm...pubmed/18534556
NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.

https://www.ncbi.nlm...pubmed/25004186
the study provides only limited support for the role of NAC as a novel adjunctive therapy for MDD.

https://www.ncbi.nlm...pubmed/21719110
These open label data demonstrate a robust decrement in depression scores with NAC treatment

https://www.ncbi.nlm...pubmed/22891797
There were no significant between-group differences in recurrence or symptomatic outcomes during the maintenance phase of the trial;

https://www.ncbi.nlm...pubmed/27725170
The anxiolytic effects of NAC were comparable to diazepam.

[fishinghat]

IUN

"What is your decision of N-ace over the Glu?"

Just one thing I wanted to add sort of a pet peeve of mine. The abbreviation Glu has been used for 11 different chemicals (including glucose) and medical conditions over the years. I assume you meant glutamic acid or glutamte.
You are correct that it is the go to treatment for things like Tylenol poisoning.

https://www.ncbi.nlm...pubmed/29045497
modulation of Glu transporter expression may restore Glu (Glutamate) homeostasis.

https://www.ncbi.nlm...pubmed/24676047
These studies evaluated the role of NAC (N-acetylcysteine) in cocaine dependence (three studies), cannabis dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled.
The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and cannabis dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction.

https://www.ncbi.nlm...pubmed/27179791
Furthermore, NAC was able to rescue changes in key glutamate receptor proteins related to excitotoxicity in HD, including NMDAR2B. Thus, we have shown that baseline reductions in cysteine underlie glutamatergic dysfunction and depressive-like behavior in HD and these changes can be rescued by treatment with NAC. These findings have implications for the development of new therapeutic approaches for depressive disorders.

I found dozens of articles that showed that NAC help stabilize glutamate levels in the brain.

[fishinghat]

OK so how are things going?  Pretty fair. So far I have went from a 0.0067 mg drop every 3 days to a 0.027 mg drop every 3 days. The main factor has been the 600 mg of N-acetylcysteine(NAC) I have been using every other day. On the day I use it I can feel a noticeable improvement of around 50% in my symptoms. I would like to mention to everyone that my symptoms are minimal at this slow a drop rate, not comparable to Cymbalta withdrawal. As soon as I feel stable I will go to taking the NAC daily and then if stable I will drop a little faster again.

 

So right now...

500 mg of Vitamin C on Mondays

600 mg of NAC every other day

150 mg of Zantac every day.

 

Currently dropping 4 times faster than before. Symptoms tolerable (Some agitation but mostly stomach issues).Use Imodium, Kao Pectate, peppermint lozenges and simethicone to control those symptoms but they are light and transient.

[invalidusername]

That second paper sounds really interesting with the mention of "pathological gambling". Clearly it is an addiction, and potentially a form of compulsive action, but I have not ever seen a study used in this context before. I can imagine the conversation at the Doctors...

 

 

PATIENT: "Doctor, I have a gambling problem"

 

DOCTOR: "Here, take some Cymbalta - that will sort you out!"

 

 

Glad to hear about the progress thus far, and really interested in the NAC insomuch that you say a 50% improvement in the first dose.

 

So could you clarify exactly which of the symptoms this has improved? Is there a means by which one could work out a suitability for others in a similar withdrawal state??

[fishinghat]

As N-acetylcysteine is an antioxidant the dosage necessary would depend on the individual and the circulating free radicals in their system. Most studies that dealt with addiction, withdrawal and poisoning use doses around 1000 to 1500 mg per day unless it is an acute poisoning.
 
My symptoms aren't bad during the day. Starting around 4 pm I start just feeling bad and draggy, by 6 pm I am a light to moderately  agitated, some heart pounding and light hyperventilation and I have stomach issues (bloating, churning and  queasiness). Less than an hour after taking the NAC I am feeling calmer, happier and more relaxed but of course it does nothing for the stomach issues. That is what the stomach meds are for.
 
One thing I wanted to point out from the research is that it has a direct effect on Glutamate, the main excitatory neurotransmitter. It modulates its blood concentration. Modulates means that if levels are high it lowers them and if levels of glutamate are low it raises them. So essentially the glutamate levels are keep in a relatively stable middle of the road concentration. This is important because glutamate control GABA production. GABA is the main calming neurotransmitter that does the primary blocking of synapses when not in use. So by stabilizing the glutamate production you also stabilize the GABA production.
 
As we all know, stability is a good thing during withdrawal. We don't like extremes.  lol

[gail]

Fishinghat,

Before trying those health products, did you have those symptoms? Agitation, graggy, heart pounding etc ?

If so, would you attribute this to the lowering lorazepam a teeny bit faster?

And before the lorazepam lowering and trying natural products, would you say that you were doing real good? Thank you Sir
Sorry, I hadn't seen the previous posts.

[fishinghat]

Oh yes, before I had no benzo withdrawal symptoms at all. I was fine. That was the benefit of withdrawaing so slow but I got to thinking that this was a good time to "test" some products that may help with the withdrawal. I increase my drop rate just enough to get these light symptoms and then started the testing I have documented here.

And of course, more to follow.

[invalidusername]

This has got me interested and am current reading more literature... and FDA approval since '63 is a good start, and a high tolerability for oral doses across the board.

 

Have found a very nice paper which contains details of current clinical trials. 

 

"One case study (N = 1; LOE 4) reported significant improvement as evident by drop in CGI-S from 5 to 2 after 8 week treatment with NAC in a 17 yo male with generalized anxiety disorder and social phobia who previously failed both multiple selective serotonin reuptake inhibitors and cognitive behavioral therapy"

 

"A large randomized controlled trial (N = 252; LOE 1b) in individuals with major depressive disorder (MDD) and MADRS score ≥ 18 showed improvement in multiple outcome measures – in the NAC group when compared to placebo add on treatment to usual treatment for 12 weeks (Berk et al., 2014). There is also a case series (N = 2; LOE 4) that showed successful and sustained improvement of depressive symptoms on NAC augmentation in two patients with MDD who had responded only partially to a trial of monoamine oxidase inhibitors (MAOI) tranylcypromine"

 

 

Found the full PDF on ResearchGate. Not sure if you can get full text, if not, let me know and I will email it over.

 

https://www.research...stematic_review

 

This could potentially make a significant different in place of withdrawal by use of another SSRI. This is a great find Hat. 

 

Need to read more.

[fishinghat]

Yes, the effects on depression are well documented and would certainly help at least minimize the use of an ssri or snri. Medical use of NAC was a real hot button issue in the early 50's (I told you I was old) but by 1960 the experts had moved on to other interests. I will check out that article and let you know if I need it.

[fishinghat]

I did not have that one but I do now!!

Tx

[invalidusername]

No problem - I'm still going this end

[invalidusername]

Another good read;

 

https://www.scienced...278584613000420

 

"Considering the advantages consequent to lowering antidepressant effective doses the results of this study suggest a potentially clinical useful interaction of NAC with imipramine and escitalopram."

 

"NAC may be an ideal candidate to translate to clinical setting the concept of potentiating ADs effects with glutamate antagonists."

 

"Our data show that NAC interacts selectively with different ADs, indicating that specificities in how different agents affect glutamate function are of relevance."

 

So it looks like NAC can benefit the effect of some AD's but maybe not others. Therefore being on Escitalopram, and the fact that it has shown improvement in the lab, it might be worth a try. The only question remains as to the dosage as those administered in the lab seemed to be cruicial to the improvement. Too little or too much did nothing (pg127).

[invalidusername]

Link to the previously mentioned AD-resistant case - 1200mg twice daily reduced CGI-S from 5 down to 2, which Sertraline failed to do. 

 

https://www.research...sistant_Anxiety

[gail]

You guys are awesome! Real interesting reads, thanks!