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Hypnic Jerks / Too Much Serotonin


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#1 Ramona80

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Posted 02 July 2015 - 12:03 PM

So since my doctor increased my Cymbalta dose, I've been having trouble getting sleepy. Even when I'm exhausted, I have a hard time getting sleepy enough to fall asleep. Once I start to fall asleep, I have a hypnic jerk that startles me awake. This goes on over and over for anywhere from 1 to  5 hours. The same jerks happen if I try to take a nap during the day. 

 

I am weaning down now (per doctor's suggestion), in a couple days I'll have dropped 10 mg. Still having the jerks and getting very little sleep. 

 

From what I've read, sometimes starting an antidepressant, or having an increase of an antidepressant dose can do this. 

 

Any knowledge of anything that helps with this? I have looked online and I see that doctors often say to take Klonopin but I don't want to make that a habit. I am thinking of returning to my acupuncturist, but I asked and he never treated that before. (They do treat for insomnia, though, and the treatments balance the nervous system.)

 

 

 


#2 Ramona80

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Posted 02 July 2015 - 03:27 PM

Holy crap. So I can't get a hold of my p-doc for a while, so I spoke with another doctor who said I'm experiencing a Cymbalta overdose. The insomnia, hypnic jerks, hyperactive reflexes, very fast heart rate, metallic taste in mouth all mean too much serotonin. He said keep weaning! Jeez Louise. (Wondering how I am experiencing this on 90 mg, when some people are able to be on 120 mg.)

 

Anyway, I am almost down to 80 mg. I wonder if I should wean faster. I am taking out 10 beads per day at this point. 

 

ALSO! Back in April when I first ended up in the E.R. I wondered if I had serotonin syndrome. At that time, I was on 50 mg of Cymbalta and my p-doc added 10 and then 20 mg of Celexa. After bumping that up to 20 mg I had all sorts of problems. When the E.R. doctor hit my knee with that little rubber hammer, my leg flew out instantaneously and almost kicked him. He said, "whoaaa" and looked at me. I said "what?" He said, "I've never seen a reflex like that before." And he looked like he was thinking about it for a few moments. I asked him about serotonin syndrome and he said "No, if you had that you would have a high fever and a lot of other symptoms that you clearly don't have."

 

Well, it turns out that serotonin syndrome can be mild, moderate, or severe. In the milder cases you don't see the high fever and the life-threatening effects of the more serious cases. How did the E.R. doctor not know this?!

 

Anyway any advice on whether I am weaning too quickly? Going from 80 to 70 mg if I continue at the 10 bead per day rate is that too risky?


#3 thismoment

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Posted 02 July 2015 - 06:21 PM

Hi Ramona

 

Sure sounds like Serotonin Toxicity, which is the term preferred by many physicians as it more accurately describes the condition. You will recall, SSRIs and SNRIs are neurotoxins and toxicity is always a possibility.

 

Are you currently taking any other drugs that boost serotonin?

 

The sleeplessness was definitely part of using this drug for me. I found that if I avoided napping in the day and walked a lot, I could fall asleep more readily. But it didn't really begin to improve until I was off the stuff.

 

Take care.


#4 Ramona80

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Posted 02 July 2015 - 06:33 PM

No other drugs. I was taking Vistaril at the lowest dose, but I've stopped that now. 

Do you think lowering 80 to 70 mg at a rate of 10 beads per day is too fast? That would be dropping another 10 mg in 6 days. 

I would not do my entire taper off Cymbalta at this rate, I just want to get down to a level where I'm not in a toxic state.


#5 thismoment

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Posted 02 July 2015 - 08:51 PM

Hi Ramona

Only a physician trained to diagnose Serotonin Toxicity could say for sure if you are in a toxic state or if your symptoms are part of withdrawal; it's just not helpful to guess, even if the symptoms do point toward ST. While it sounds like some degree of Serotonin Toxicity, a true diagnosis is needed.

Otherwise, you're following a hunch, a belief. Beliefs aren't facts. You simply must accept the things you don't know, and let the hunch or belief go; if you hang onto a personal story of the unknowable, it has a way of occupying your mind in a kind of mental vortex that cannot ever resolve. 

Regarding the rate of tapering-- if your 10 mg in 6 days brings on symptoms that are difficult to manage-- you're tapering too fast. As a place to start, I would consider reducing from 80 mg over not less than 4 months (16 weeks). That would yield a reduction rate of 5 mg per week.

As always, wait and see how the symptoms express and adjust accordingly.

Take care.


#6 Ramona80

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Posted 03 July 2015 - 10:18 AM

During someone's taper, do they ever just pause and hold at the level they're at for a while (even if NOT experiencing withdrawal symptoms) just to let the brain/CNS kind of catch up a little?


#7 fishinghat

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Posted 03 July 2015 - 01:46 PM

Not that I have ever heard of but most are in a hurry to get off the stuff.  lol 

 

It sure wouldn't hurt anything though.


#8 thismoment

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Posted 03 July 2015 - 03:29 PM

Ramona

I agree with FH.

It's all about quality of life, and only you can decide what that means.

If you've encountered a comfortable place, why not stay for a while?

If you're NOT experiencing withdrawal symptoms, it means your brain is healing just fine; the symptoms will let you know when your brain's healing can't keep up with the rate of dosage reduction.



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