Kindling and prolonged withdrawal symptoms

[[Po...]]

HI BBs:

 

I can't recall what I have and have not posted here as I came over from The Trap after it closed down and I can't seem to find what I have posted either. So will give a very breif summary and then get to my question.

 

I took Xanax for 25 years, got off of it in 2008 after a 20 month taper. Everything was going good, then I had to go and futz it up. When I travel I get very anxious and dont sleep well, which leads to more anxiety which leads to more sleeplessness and I end up a basket case. So I have dabbled with taking a low dose of valium for a few days  at a time to get me "over the hump" when I travel. I acknowledge, not a smart thing to do Pokey.

 

Fast forward. I have not taken a dose of valium for some time. I am benzo free, but I am feeling miserable much of the time. The symptoms could be summed as extreme fatigue & malaise, GI distress and feeling like I have the flu much of the time- in general feeling like crap or warmed over dog poop!! There is no medical reason to be found for feeling this way, I have had lots of tests and the doctors are puzzled. I do have a heart condition and GERD, but they claim that neither is the cause for my sxs and blood tests reveal nothing either. My psych doc thinks its dysthymia. I was treated for major depression 30 years ago and struggle with depressed mood often. That may be part of the picture, but I tend to get depressed becuase I am so tried and feel like crap. I dont feel like crap because I am depressed is my take. when I exercise I feel much better, both mentally and physically, so I dont think dysthymia is the root cause of my not feeling well. I still take an AD.

 

I think whats going on being there does not seem to be any other medical explanation is I am having prolonged WD sxs due to kindling effect from taking and stopping benzo several times when traveling as noted above. I dont really understand kindling and was wondering if a moderator here could explain a bit and I'd like peoples opinion if they think thats whats going on with me as well. My best take on kindling is that its a resensitization of the benoz receptors that has and additive effect and thus makes WD form the drug worse. If I am correct  that means I am just going to have to live through it I guess as there seems to be no other options. The big question of course for me is how much longer is this misery going to last and I wonder how I will ever travel again, because travel really messes with my nervous system.

 

Pokey

[[br...]]

Sorry to hear about the troubles...

 

Have you ruled out your AD as a possible causal factor?  They can stop working, and people switch or change types. I'm sure you're aware of this.

 

Conversely, could very well be WD... though you seemed to get lucky after quitting the X for that long.

 

I also wouldn't rule out organic stress or TMS.  Anxiety can wreak havoc, as you know. For some reason... we can usually tell the difference between anxiety and WD, though.

 

I hope it improves for you, and I hope you can find more clues to what's going on. Try to relax your attitude towards it and know you'll figure it out in time.

[[Ja...]]

I re-read the Ashton manual the other day, and there she talks about withdrawal-like symptoms reoccurring, as they become part of your symptom "repertoire" and are triggered in times of stress or depression. I am paraphrasing here, but i think it is a correct interpretation with your (and many others) situation in mind. Interestingly, I was thinking "depression" right before I read your own words stating the same thing. This of course is more likely to be your answer than anything else, as you know your self better than most, and you are no stranger to gauging psychiatric symptoms, sounds like. The fact that you feel better after working out supports the idea that this is not some heavy, down-spiraling episode of depression. Instead, it is one of those times when you tend to feel down, and can pull your self out of it by staying positive and doing the right things.

[[Ja...]]

In regard to kindling, you are correct. But I do not think this is your problem at this point, if your last run-ins with benzos were around 2010. You should carefully evaluate your other med intake for cross-tolerance with benzo, including any alcohol intake!

 

I found kindling a difficult topic to research as it quickly takes a deep dive into seizure activity and epilepsy..

[[Po...]]

Jake- No I don't think its a spiraling depression syndrome that I am dealing with either, I think I get depressed because I get so damned tired and feel bad. After I work out, say an hour later I feel pretty good. I skiied 10 K sunday and felt fine Monday and then woke up this a.m. feeling awful and had to come home from work I felt so bum. My last interlude with valium was before Christmas btw, not 2010. I have had about every blood test known to man, had a sleep study and all were normal. I have a leaky heart valve, but its stable and heart valve problems dont cause the kind of symptoms I am having. I can say in the past when I did tale a couple days of valium all the symptoms vanished, including the gut sxs. Then as time passes they start creeping back and amplifying. The interesting thing is I am not having any real anxiety, no panic, but that might be because my AD has some anti-anxiety effects. My symptoms are pretty consistent: fatigue, flu-like symptoms, just feel yukky, sometimes toxic, gut pain all of which make me lethargic and wanting to lie down alot. I often haveto force myself to exercise, I do becuase I know it will make me feel better. Maybe thats what I am going to do, work exercise into my day 5-6 days a week instead of 3 which will be a challenge. I have went on/off the valium for travel because my psych doc claimed it would be OK. I guess we all have heard that before. But he's smart and cares and is a thinker. I think he believes me that all this fatigue and malaise I talk to him about is related to my stupid dabbling with the valium

 

Pokey

[[Ja...]]

Just noticed your signiture line:

 

Doxepin:  My doc actually prescribed me this at one point as a sleep aid to counter balance a heavy Dextro Amphetamine prescription. If you look at it on Wikipedia, you will see it is cross-tolerant with benzos to a high degree. It can also produce many of the 'toxic' feelings you describe.

 

Verapamil:  Mechanism in all cases is to block voltage-dependent calcium channels (this in some sense is also cross tolerant with benzos). Side effects of the drug are headaches, facial flushing, dizziness, lightheadedness, fatigue, nausea...

 

I am not saying that you should or should not take these meds, but only that they are more then likely your issue. In this case, kindling and cross tolerance would be felt, for example, when tapering off one of the meds, and then introducing and removing something like Valium, it can be like taking a much bigger cut in the taper schedule for the AD. This would also happen every time you upped or lowered any other cross-tolerant med you are on.

 

I think completely eliminating the AD will be a big help, considering it is not a simple SSRI, but a  tricyclic.

[[Ja...]]

This is from Wikipedia in regard to Nexium:

 

Esomeprazole is a competitive inhibitor of the enzymes CYP2C19 and CYP2C9, and may therefore interact with drugs that depend on them for metabolism, such as diazepam and warfarin.

 

(This essentially intensifies the cross-tolerance of any CYP dependent drug)

[[st...]]

Hi Pokey,

 

My last Xanax was Aug 2008 and I am still dealing with the symptoms you have been mentioning.  As a matter of fact, that total body weakness subsided a couple of months ago but I do have quite a bit of fatigue still going on.  My intestinal tract is still not back to normal (although improving slowly).  I never felt depressed until the last few months but I think it is from fighting to survive for so long.  We need a break.

 

IMO, Jake has some good thoughts, too.

 

I remember you on TRAP.

 

Patty  xo

[[Po...]]

There is no option on the verapamil. I have a mitral valve problem that its helping mitigate the effects of, the other option is a beta blocker which I definitely cannot tolerate and the verapamil so far is keeping me away from open heart surgery, so I'd just as soon take the verapamil as have my chest cracked and my heart stopped and cut into. I am on a low dose, 120mg 1x/day

 

Doxepin- I have taken it for 25+ years and not had a problem with it previously. I asked my psych doc to look into any problems with it and verapamil. He looked at all the data on the cytochrome enzymes involved and did not find a problem between the two. I think taking doxepin while I came off the xanax made my taper relatively easy.

 

I am not sure what you mean by cross tolerant? Do you mean they are compatible togther? I will talk to my doc again about drug incompatability. You brought up some good points. Thanks much

 

Pokey

[[Po...]]

HI Patty- yes I remember you from the TRAP too  I did not know, or forgot that xanax was your benzo of choice. I took the stuff for 25 years. Docs kept tellingme I was broke and "needed" it. Then I did my own research and realized I didnt need it. It took me 20 months to get off 2 mg via valium cross over. I was doing fine and then I had to go and muck it up with taking some valium when I traveled. It worked and was fine a couple three times, but then things started not being great and thats why I am back to a forum like this. You said your symptoms were similar to mine, would you be willing to share a bit more detail on your sxs. I'd like to compare apples and oranges. Great hearing from you Patty

 

Pokey

[[Me...]]

I am telling my counsellor the symptoms and trying to get her to understand that I want to try tapering everyday 1%.  When I described the symptom, my WD syndrome, which  seems to be unique for everyone, she says I must be getting depressed.  I told her that I was depressed briefly when my landlord was hasssling me, but I felt it was more of a post tramatic stress as when men hassling me at points of my life, I end of depressed!  No surprize! 

 

She said sleeping too much is a sypmtom and also can cause depression, but I told her that when I sleep a lot more than usual (i.e. when my son is in respite care) then I feel terrific and quite happy.  I have energy to enjoy my son and dance tango, etc. so how can I be depressed?  Then she says, well then I should walk.  When I walk, I trip up and become clumsy, my words are slurred, I have amnesia, a whole host of symptoms, but when I dance (something I haven't done in years (or sew or swim) I loose nearly all my symptoms, or if I am well rested.  So she wants me to walk... forget that, I will fall right over and it will exhaust me.

 

So is that kindling, I don't know.... but breaking out of my usual pattern seems to be working for me.

 

Trying to tell the doc that what is right for me just makes them want to give me another diagnosis.  I hate it.

 

My diagnosis is benzo withdrawal and that is what I need to focus on.. so what about treating the symptoms.  Treat the withdrawal with something that is working for you.  If you need sleep, then sleep; need exercise, then exercise.  Anyway... I am just sick of it.  I want to avoid all benzos and alcohol but I am now on mood stabilizers, which will be evaluated as not working, so no doubt they will be increased (which makes me way sleepier)

[[Po...]]

 

Memories- It does not sound like kindling is what is going with you from what you described. See the definition below from Wikipedia

 

Kindling is the phenomenon which occurs as a result of repeated withdrawal from benzodiazepines or alcohol that leads to increasingly severe withdrawal symptoms, including an increased risk of seizures. Ethanol (alcohol), has a very similar mechanism of tolerance and withdrawal as benzodiazepines, involving the GABAA receptors, NMDA receptors and AMPA receptors; these receptors are involved in kindling. The research into kindling, a phenomenon which results in increased sensitivity of the nervous system due to multiple acute withdrawals with for example increased seizures, has primarily focused on alcohol.[1]

 

Pokey 

[[Ja...]]

There is no option on the verapamil. I have a mitral valve problem that its helping mitigate the effects of, the other option is a beta blocker which I definitely cannot tolerate and the verapamil so far is keeping me away from open heart surgery, so I'd just as soon take the verapamil as have my chest cracked and my heart stopped and cut into. I am on a low dose, 120mg 1x/day

 

Doxepin- I have taken it for 25+ years and not had a problem with it previously. I asked my psych doc to look into any problems with it and verapamil. He looked at all the data on the cytochrome enzymes involved and did not find a problem between the two. I think taking doxepin while I came off the xanax made my taper relatively easy.

 

I am not sure what you mean by cross tolerant? Do you mean they are compatible togther? I will talk to my doc again about drug incompatability. You brought up some good points. Thanks much

 

Pokey

 

I am certainly not suggesting you stop the verapamil! Only that the combination of the meds you are on now, combined with the effects of a benzo withdrawal, are a fitting explination of why said withdrawal is more intense or protracted.

 

For example, when taking Valium for travel, and combining with Nexium, the half-life of the V is extended from the documented 200 hours to longer. How much longer, depends on you and your Nexium dosage. This is neither good nor bad, but simply needs to be accounted for. If not, the end result of combining V with Nexium is like increasing the V dosage without realizing it. Your doc may not think its a big deal, because under normal conditions it is not, but when you are dealing with a benzo withdrawal + a Tricyclic AD taper/withdrawal, it is more of an issue.

 

With Dexepin, you may be tolerating it ok, but when tapering off of it, as you are now doing, this creates a withdrawal from Dexepin's sleep-inducing and anti-anxiety effects, which combine with the benzo withdrawal effects which are similar, and this combination creates unexpected symptoms that you are sensitive to.

 

The cross-tolerance between the Dexepin and the benzos, although not used in the strict sense of the term here, is exactly what made it easier for you to taper off the benzo by taking the Dexepin. In the same way, however, the withdrawal from Dexepin intensifies the withdrawal from occasional Valium and vice versa. I am not sure how much the doctors can help here, this is the predicament we all seem to find our selves in..

[[Po...]]

Jake- I appreciate the discussion you are presenting. I dont understand your point about nexium and valium though, all the drug interaction info I can find says there's no problem interactions between the two, am I missing something?

 

And I should update my signature, I actually upped my AD, the doxepin to 100mg over 2 weeks ago, perhaps this is the result of needing to do so for the reasons you mentioned below, the WD sxs forcing the issue. Today I must be in one of the so called "windows", I actually feel pretty OK today, but I am not optimistic yet as we all know things can reverse the next day or the next and one will be back in the doldrums.

 

I wonder about this kind of thing alot and I do know the docs don't know how all these drugs interact. I have one doc that thinks that once all the benzo is out of your system there should be no more WD symptoms, for a guy with a medical degree he has no clue, at least about these kinds of drugs. He is a gastroenterologist who I see for a gut issue. I told him that when I take some valium my gut issue disappears and he said thats probably because the valium relaxes smooth muscle, which lines much of your GI tract and thats why the cramps and pains stop. But he doesn't think that being off the drug is the cause of the symptoms after its all metabolilzed, which we all know is not necessarily true.

 

I am almost 63. I have a sensitive nervous system and I may never be immune to things like travel and other stresses. Sometimes self talk only goes so far and then the nerves take over, so I have come to peace with the fact that I may need to take the doxepin the rest of my life for both my anxiousness and my tendency towards depression. If I can get out of this life only on doxepin for these things and never take another benzo again I will be a fortunate human being.

 

Pokey

[[Me...]]

Thanks Pokey,

 

I never drank alcohol, so that is not the issue, but I started with Zopliclone, then ativan and then clonazepam and now valium and it does get harder (particularly the hardest with Clonazepam.)  I've been on Benzo's over a year now and daily for most of it.

 

i think I read somewhere that taking Benylyn crossed over while I was taking a daily dose of Clonazopam.  My original Dx was recurrant Respiratory infections putting me off work at the hospitals.  My Ears Nose throat doc advised me that at the very onset of a viral infection that I was to take Benylyn and Otravin for three days.  I repeated this several courses until the infections stopped recurring. 

 

So I wonder if it is true that Benylyn (first gen anti-histamine) is a kindler?

 

Also I wrote that previous post in a mind fog, so I can't claim the content to be totally relelvent, so I apologise for that.

 

I just started a prescription of prednisone.  Docs and pharmasists all said OK! It worries me.

[[Ja...]]

From WIKI

 

Esomeprazole (Nexium) is a competitive inhibitor of the enzymes CYP2C19 and CYP2C9, and may therefore interact with drugs that depend on them for metabolism, such as diazepam (Valium) and warfarin.

=============

 

It isn't a direct interaction, although I do remember interaction finder apps like on WebMD catching stuff like this. Just think of the CYP enzymes as the body's HAZMAT (Hazardous Materials) disposal service. The Nexium puts these guys on leave/vacation, so your hazardous waste, such as the Valium you take, is getting picked up from the back of house every other week instead of once per week like when all the CYP guys are at work and not off. So you might expect a week's worth of Valium garbage in the dumpster right before garbage pick up time, but you actually have two week's worth..

 

As far as Dexepin, it may be a good med for you. The only thing I would say is, to try avoid benzos as they are cross tolerant with Dexepin. It may be difficult for you to get off the Dexepin because there is an equilibrium between your heart medication and the norepinephrine reuptake inhibition of the Dexepin (here, the Dexepin is acting as both a stimulant and a depressant). Given your heart condition, I would speak with SEVERAL different docs about their opinion of you mixing this medication with the heart medication. And, if you do chose to get off the AD, make sure and make your taper SUPER SLOW!

 

The docs mean well, but they have lots of patients. We have to use the fact that we have access to many of them to our advantage, and most importantly, to be in charge of our own well being, using the docs as outside consultants.

[[Po...]]

Jake- I have read there is a mdoerate interaction between doxepin and verapamil. I asked my cardiologist about it and he said he didn't think it a problem. Of course I am not sure what he means its not a problem, will it kill me, not likely, will it make me feel like crap, I never asked him. I did ask my psych doc about the two and he was not of the opinion there would be a problem either, but then I know I am really senistive to drugs. They tried me ona mere 25 mg of toprol once, a beta blocker and I could hardly climb a set of stairs it slowed my heart and lowered my BP so much. My brother takes 100mgs of toprol and he says its not a problem for him.

 

As for the nexium and valium if I understand you the only problem there would be the valium hangs on longer. What about the nexium a and verapamil and doxepin, will it make them hang around longer too. I am going to talk to my docs and a pharmacist about this more. DRug combinations may be part of the problem, or THE problem.

 

Pokey

[[Po...]]

Jake- one more question are you pharmacist or pharmacologist by chance

[[Ja...]]

What about the nexium a and verapamil and doxepin

 

From drugs.com

 

Inhibitors of CYP2D6: potential pharmacokinetic interaction (increased plasma doxepin concentrations) with concomitant use of CYP2D6 inhibitors; use with caution.a k l Consider doxepin dosage adjustment whenever a CYP2D6 inhibitor is added or discontinued.a k l

 

Nexium inhibits CYP2C19 and CYP2C9, so all good there.

 

However, the topic of this thread reads 'kindling', and cross-tolerance goes hand in hand with that. Here is what the lit has to say about that:

 

Withdrawal symptoms frequently seen when treatment with doxepin is stopped abruptly (agitation, anxiety, insomnia, sometimes activation of mania or rebound depression) can be avoided by reducing the daily dose of Doxepin gradually by approximately 25% each week. If treatment has to be stopped at once due to medical reasons, the use of a benzodiazepine (e.g. Lorazepam, Clonazepam, or Alprazolam) for a maximum of 4 weeks as needed will usually suppress withdrawal symptoms.

 

and

 

...other antidepressants, barbiturates, narcotics, sedating antihistaminics, anticonvulsive drugs, alcohol - resulting in increased central depression

[[Ti...]]

I have had these exact symptoms just recently when I dropped Ativan crossing over to Valium.  It is crushing fatigue and whole body weakness and flu symptoms (also weird head sensations).  I am wondering if this withdrawal could trigger Chronic Fatigue Syndrome as my symptoms match CFS exactly.  Have never felt this way before in my life and have always have had TONS of energy so I know it is from w/d.  Also it might be Adrenal Fatigue.  I really hope since it is w/d and not anything else that it WILL eventually go away.

 

Stoney--gosh, it took years for your body weakness to go away?  Man, that is awful--I am so scared I will be in that same boat.  At least it went away for you though right?!?!? 

 

Definitely not depression for me, as I love my life and when I feel good and not fatigued I am beyond HAPPY.  It's all these symptoms that make me feel so sick and down...

 

I just hope it all goes away for all of us eventually.  Life is too short to put up with this crap.

[[Po...]]

 

Jake- you posted the following

 

Withdrawal symptoms frequently seen when treatment with doxepin is stopped abruptly (agitation, anxiety, insomnia, sometimes activation of mania or rebound depression) can be avoided by reducing the daily dose of Doxepin gradually by approximately 25% each week. If treatment has to be stopped at once due to medical reasons, the use of a benzodiazepine (e.g. Lorazepam, Clonazepam, or Alprazolam) for a maximum of 4 weeks as needed will usually suppress withdrawal symptoms

 

I am not withdrawing from doxepin, in fact I upped the dose 3 weeks ago. Whatever is going on is wearing me out. I woke today exhausted and feel like crap, like I have the flu. My wife and I are supposed to leabe a wekk from today for Oregon to look for retirement propeorty, not sure I can make the trip. Geez this is miserable, whatever it is.

 

Pokey

[[Me...]]

Oh man.. I was taking Nexium with Benzo because I was taking naproxen to cut the intense pain that I beleived a fall caused (but actualy tolerance  WD)  Argh!  you can't win with drug iteractions!

 

I might end up taking naprozen again due to my newly diagnosed condition, but I can't take it without a PPI like nexium or my stomach hurts.

[[st...]]

Hi Pokey,

 

I always have to remind members that I took Xanax due to Levaquin toxicity which has the same effects as benzos.

 

I had total fatigue along with body weakness for over 3 years.  After the 3 year mark off date I had a bit more energy......not great but alot better.  I still deal with lack of ambition/motivation/lethargy. 

 

Flu-like symptoms still haunt me, too.  Once in awhile I have a decent window so I know it is all related to this process.

 

Bowel movements are very soft and sometimes frequent and I still have alot of bloating but I do find when I am restricting my diet that the benzo belly is not as intense.

 

I still have anxiety, especially in the mornings and after dinner.  Vision problems continue (blurred/flashes/white shadows, etc.).  I continue to experience quite a bit of mucous production.  There are a few other things still going on, too.

 

There are several of us under 'Buddie Space' that are dealing with protracted problems over between the 3-4 year mark.  Some of us only blog ocassionally but we keep in touch.

 

Patty  xo

[[Ti...]]

Stoney-so sorry to hear about your rough past few years. I took cipro 15 years ago and am wondering if it could have sensitized my CNS. Also took steroid treatment in oct. Same month started the Ativan. And unknowingly went through w/d after taking Valium for a short time in 2006. Could cipro toxicity be long lasting?  The fatigue is scaring the crap outta me as I can't do anything with it. I have a 2 and 4 year old!  It is total like you are describing. Do you still see improvements in you sx this far out and anticipating a full recovery? Have you been dx with CFS or is benzo wd fatigue considered separate with a better prognosis?  I wish you all the best.