Hi all,
I recently ended up in the ER twice in the last couple of weeks and am trying to price together why. Since, I feel like I'm still not at baseline. I was hoping anyone with some neurotransmitter experience could help shed some light on what's going on?
Leading up to these events I was sporadically taking .125 Klonopin about 2-3 times a week, desoxyn 15-20 mg 2-3 times a week, and recently went from using mirtazapine 3.75 mg 7 nights a week to 3-5 nights a week when I suspected PVCs were due to the mirtazapine. Melatonin 5-20 mg nightly with opther supplements like probiotics, magnesium, fish oil, multi-vitamin. Occasionally Valerian, Lemon Balm, Holy Basic etc for rough nights I couldn't sleep without the mirtazpine.
2/12/18 10:00 pm: Mirtazapine 3.75, Tryptophan 1000 mg, Magnesium Threonate, Melatonin 10 mg, probiotics (66 billion).
2/13/18 7:00 am: Woke up feeling groggy. Took my ADHD med (Vyvanse 60 mg) before work and within minutes knew something was wrong. Way too overstimulating within minutes (high BP and rate- extreme agitation). Took a Klonopin .25 and was able to calm down and make it through the day
2/13/18 11:00 pm: Started with meditation and binaural beats. Took my usual dose of Mirtazapine 3.75, Magnesium Threonate, Melatonin 10 mg, probiotics (66 billion). Within minutes I noticed my legs cramping, then my back twitching. I felt depersonalization/derealization. Soon I was pacing the bedroom shivering with a heart rate of 130 and could feel PVC arrhythmias every few beats. My wife took me to the ER. On the way I took a Klonopin again, a .125 mg. They took my blood pressure upon arrival at 170/110. By the time the doctor came in to see me everything had calmed down to baseline. I had a normal EKG and he discharged me with a prescription for Metoprolol.
Immediately ceased taking Mirtazapine which I suspected may have caused Serotonin Syndrome when combined with Tryptophan. Started Metoprolol but 12.5 mg. Stopped taking Magnesium Threonate but continued with Melatonin and probiotics. Started to take Ambien to replace Mirtazapine but didn’t use every night.
2/24/18: Was able to take ADHD medicine again but at a lower dose. Desoxyn 10 mg.
2/25/18: Took 10 mg Desoxyn and immediately felt overstimulated. I usually take 20 mg. Blood pressure shot up even with the metoprolol and I feared unopposed alpha stimulation so I took a .25 Klonopin and everything returned to baseline.
2/26/18 10:00 pm: Took Doxylamine 12.5 mg, Melatonin 10 mg, and probiotic. Started meditating (yoga nidra) and binaural beats. Within minutes, the exact same thing happened that send me to the ER the first time. I felt depersonalization/derealization. Could feel my muscles seizing and started to shiver and tremble again. Heart skipping beats and went into full-blown panic. Took a Klonopin .125 and went to the ER when my heart started to feel tight in my chest. I thought this was it. In the waiting room I drank some cold water and it seemed to make it worse. They brought me back and gave me an IV of electrolytes. Again, EKG was normal. Blood work came back normal. Within about an hour I felt relaxed and came back to baseline, which I attribute the Klonopin. Released and told to follow up with cardiologist, which I immediately did. I’m not on Atenolol 6 mg and have an event monitor on the way.
The next few days were very uncomfortable to where I couldn’t even think. So much adrenaline. Still shaking and shivering, anxiety, weakness, out of breath, palpitations, tachycardia, and high blood pressure. The Atenolol took a couple days to kick in and when it did it took the edge of and lowered BP and adrenaline.
Possible explanations for what happened or this continued discomfort and agitation:
- Considered that all of this could be attributed to Klonopin withdrawal so I stabilized at .125 daily (it was sporadic before so could have been interdose withdrawal). I’m much more comfortable but not nearly at baseline. I’m preparing to do a slow-taper off the Klonopin.
- Mirtazapine withdrawal since I also used it sporadically before first ER visit and then ceased after first ER visit
- Serotonin Sensitivity/Syndrome: Tryptophan and Mirtazapine will do this alone when combined. ADHD meds also increase serotonin. Melatonin also works on 5HT2 receptor as does magnesium. Doxylamine does too I think? Meditation also increases serotonin. If this is from serotonin toxicity, why do I still feel amped up weeks later though?
- Been taking high doses of melatonin for a couple years. From what I understand the pituitary produces ACTH which causes hyper-arousal. Perhaps when I stopped taking melatonin my this caused the pituitary to react in some sort of withdrawal or dysfunction and causing excess ACTH and this agitation I feel still.
- Possibly 5HT2A sensitivity/dysfunction, acetylcholine or histamine issue. Mirtazapine, which I took the first time, at 3.75 works as an anti-histamine (sedating) and has anticholinergic properties. This is very similar to Doxylamine (Unisom) which I took the second time. I swear that within minutes of taking each these symptoms started. The nervous system uses acetylcholine to calm down so perhaps I have a pre-existing condition that is causing sympathetic agitation (Klonopin withdrawal, mirtazapine withdrawal, Excess Serotonin, overactive thyroid etc.) and when I took these two medicines they suppressed the para-sympathetic system’s ability to compensate. Perhaps I am now flooded with histamine? I'm shooting in the dark now lol.
- An adverse effect to meditation which can and does happen in some people
Thanks for any knowledge you can give