nortriptyline (Pamelor)

Last month I was prescribed a low dose of nortriptyline (10mg) to help with nerve pain. After a week I was told to increase my dose to 20mg. On day 9, I woke up with severe depression. I had been feeling mildly depressed on and off because of chronic pain, but this was different. It was on par with losing a family member or going through a difficult breakup. I couldn’t stop crying all day, and I remember thinking that I just wanted to die. Luckily I knew of the drug’s potential side effects, and I my mom and husband were very supportive. I stopped taking the drug immediately, and the next day I was back to normal, at least emotionally.
There was, however, another side effect that has not gone away, even now after being off it for over a month. Several days after I started taking the drug, I developed an extremely itchy rash on all my toes. My feet also became quite sweaty. The next evening, after my shower, my toes and the ball of one foot became red, hot to the touch, and swollen. The heel and my other foot still felt cool. It went away after about an hour. The same thing happened the next evening to the other foot. It progressed until both feet were flaring up every evening, and the symptoms were lasting all night long. It seemed that it was always triggered by heat. It turns out I had developed a condition called erythromelalgia. My online research has shown a link between SSRIs and erythromelalgia, and I believe that TCAs can have the same effect as well. I’ve read that the excess serotonin in the brain causes the body to stop producing serotonin, and the subsequent depletion of serotonin in the blood then causes a vasodilating effect (hence the redness and swelling).
I can only hope that my body will eventually re-regulate its serotonin levels and these symptoms will eventually go away. The neurologist who prescribed the drug is clueless and very hesitant to admit there is a connection.

nortriptyline (Pamelor)

Elisabeth

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Consumed by the Black Hole of Serotonin

“…when I looked in the mirror I couldn’t see anything. There was nothing there.”

I am (was) a Professional Bowler that bowled on the National Tour which takes the lady bowlers across many states here in the U.S. to compete against one another. This is a sport I have loved for almost all my entire life; so, when I became burned out in my regular job, I retired and conditioned myself to bowl as an athletic competitor of the sport, practicing 50-100 games per week. When I was out on the tour we would bowl anywhere from 40-60 games in 4 days and then travel 3 days only to arrive at the next destination to start the same cycle again. Needless, to say you must be in good physical condition for competition. Which I was. I participated in my last professional tournament in the Summer of 1996. Just as I thought I would see one of my dreams accomplished a dark spot began to appear on the horizon.
It showed up slowly at first before it began to gain momentum. It showed up in my consciousness as a depression of some magnitude. I had been ducking and dodging before then personal and financial problems that somehow at this point in time caught up with me and behind the awareness of my having to deal with those issues . . . the Black Hole (deep depression) appeared in its full enormity.
When it hit I was put under psychiatric care and the first doctor I saw put me on Nortriptyline’s generic Pamelor 10 mgs. starting with 1 pill and steadily increasing the daily dosage to 5 pills to be taken at bedtime. (So, that comes to 5 pills @10 mg ea. day for 7 days = 350mgs. per week x 4 weeks = 1400 mgs. per month.) I was supposed to see her in a couple of weeks. By the time I went back to the doctor I was feeling bad with what I called a toxic allergic reaction to the med. My tongue had started to get sore and become coated and so did my throat. She told me I must have a bug and to see my family doctor which I did. He gave me some antifungal medicine to take because of my tongue and throat problem. (Just treating the symptoms.) Meanwhile this same psychiatrist doesn’t bother to stop this medication. She increases it instead to 3 pills @ 25mgs ea. day at bedtime, so, this boils down to 75mgs per night x 7 nights = 525mgs. per week x 4 weeks = 2100mgs. per month. Well I did not have to worry I didn’t get any further than the end of the week and I was taken into ER that Saturday with blood pressure: 225/212 and Pulse: 96 and rising. After the physician got my vitals under control he told me to discontinue taking Pamelor. So, the drug was discontinued COLD TURKEY!!

I changed doctors after that episode and the next psychiatrist put me on 10mgs. of Prozac to be taken once daily, but when I told him about the above recurring symptoms he immediately took me off Prozac, COLD TURKEY, and wouldn’t put me on any more drugs. I checked with the pharmacist at that point to see, what was a common chemical between the 2 drugs. I was told serotonin was the common chemical. When I informed the psychiatrist of this he acknowledged that he had never had any patient that had had a problem with this med. But he took me off and told me I would have towing it from then on with the therapist. I wish I could say this was the end. But it wasn’t. The Black Hole began to consume my very being until I felt as though I was a non-entity. I lost any reason for being. I lost my self-esteem; and all of a sudden when I looked in the mirror I couldn’t see anything. There was nothing there. No image of anything recognizable. I knew then I was out-of-control. This proved itself when I had an episode in the therapist office when I locked myself in the bathroom and would not come out. I remember feeling if I didn’t come out, maybe everyone would just go away. Just vanish!! Poof!! And they would be gone. However, to this day I cannot remember what set it off. I think I must have felt that was an escape, but I don’t know what caused the episode. My reactions went from that to two attempts of suicide stopped by my husband who just happened to get there in a timely manner. Now I knew I was a part of the Black Hole and the Black Hole was a part of me. I lost my spirit. Now that I had lost my spirit, I could no longer feel myself as a person. I could no longer feel. Sometimes, I would sit staring for hours. Staring at nothing. I remember that it felt good to just sit there and stare at nothing. Everything seemed to fit in. I felt like I belonged.

My husband saw this and would take me out and make me practice bowling, or to a movie, or to a mall. But, it wouldn’t help. All I would do was cry because I didn’t want to be out there. My blood pressure went completely out of control and nothing the family physician did would bring it within normal range. Things continued this way through 1997. My husband got kidney cancer and had to have his left kidney removed. We all heaved a big sigh of relief when his health appeared good and the cancer appeared gone. I had to try to push the fog back to help him. It was hard. I remember being so afraid because each day that went by I knew I was on the edge. However, March 1998 I was back in ER again with extraordinarily high blood pressure and pulse readings. I was in there because the family doctor had become so frustrated over my condition and the fact that he couldn’t fix it that he had accidentally overdosed me with other medications to the extent that you could fill a large freezer bag full of the different medications I was on. When the cardiologist saw this after having brought my blood pressure and pulse back within normal ranges and after testing me. He put me on 3 meds to be taken once a day. I began to come back while I was still in the hospital. I began to feel like my old self. When I got out of the hospital the cardiologist put me into a monitored exercise program that the medical center has for cardiac patients and I really began to feel good. My stamina came back. My head was beginning to clear. I appeared to be moving in the right direction. I was supposed to see the doctor in 2 weeks after I left. When I saw him he put me on an additional medication Paxil @ 10mgs. one daily in the morning.

I was on Paxil a week before I realized that I was getting some of the same symptoms I had gotten before. Except this time I couldn’t get up out of the bed in the mornings to go to my exercise class. I became totally bedridden. If I tried to walk I could just barely make it back to the house before collapsing. When I talked to the pharmacist and discovered this too, was serotonin based I tried to inform the cardiologist of this problem and received the same responses I had from all the other doctors, except he went one step further. He flat out informed me there was no way that it could be the serotonin because serotonin was stored in our brains and therefore because it was a part of the body how could I be having a problem. I tried to tell him nicely that so was the heart a part of the body, but that people did have heart attacks, etc. It was finally months later before I was able to convince him to test me for 5-HIAA. By that time I was having some of the following symptoms: Swollen, coated, ulcerated tongue, diarrhea, panic attacks, anxiety to the point I felt like I was going to die, fluctuating blood pressure and pulse, tremors and coldness in the extremities. This last reaction was what sent me to ER again and since the doctor there just did not know what serotonin was, diagnosed me with hypokalemia and sent me home to take potassium 10mgs. 3 times daily.

After the Cardiologist could not find any results from the test that he took, he, too, gave up on the situation and suggested in an offhanded manner that either I was a hypochondriac or delusioned. At least that was my interpretation of an example he gave me when he told me of another patient that he had who was in her 50’s that thought she was 72. I got the distinct impression that I was being put into the same category as this other woman. So, since April 1998 I have been free of all serotonin drugs. I have even tried to stay away from foods that might increase the level of serotonin in my body. But, I was not to escape!!

I began to experience severe gastrointestinal problems. So I went to a gastroenterologist and he first of all did an endoscopy to check the upper stomach. He found ulceritis of the stomach and a sliding hiatal hernia. I wish I could have said I was surprised, but by this time I had discovered after doing some research that serotonin does reside in the stomach also. You may be asking where do I stand now. The only thing that I can tell you is the depression has left. I cannot tell you when I left the Black Hole or when it left me, but it’s gone. Meanwhile, the family doctor will be sending me to an endocrinologist for the serotonin issue. I will be going back to the gastroenterologist to get a Colonoscopy to determine why my bowels stopped functioning and my stomach remains distended and when I do get my bowels to function with laxatives I go from diarrhea to constipation to diarrhea.

When my eyesight became blurred I had my prescription changed. The skin rash I suffered on my arms and thighs went away. It did create a minor gingivitis situation with my gums that I will have to have fixed in May. I have a vaginal infection that I am currently seeing a gynecologist about. I had some hair loss on the crown of my head. The scalp would itch, but there was no dandruff and I would wash my hair a lot and treat it with sulfur based hair conditioners.

I have approx. 20 lbs. of weight gain that did not occur from abusive eating, sweets, or alcohol. And, I do not smoke. I am living one day at a time. Dr. Tracy’s book has now come across my path so I have already ordered it. I have to believe that one day I will stop going around and around this vicious cycle that I feel has been set up in my body by these mood altering drugs. I am looking forward to the day when it all stops for good and I can really go back to being normal.

Percetta Speight

6/10/1999

This is Survivor Story number 29.

Total number of stories in current database is 96

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