As I sit down this Thursday morning, it’s a year and four days since I stopped taking Amitriptyline. Up to that point, I’d taken varying amounts every day for the past 25 years. It’s impossible to know while you’re taking an antidepressant how well you’d feel without it. Through the good days and the bad, at every waking moment, it’s there affecting you; maybe subtly, maybe not.
I’ve begun to wonder how much of my personality over those years was the drug and how much was me? Was I a little Amitriptyline, half Amitriptyline, or more than half? Was I the drug or was the drug me? Would I have still been me without the Amitriptyline? It’s an unsettling thought.
I can’t remember the number of times that I’ve put pencil to paper since writing my last MHH blog post, some three and a half months ago. I don’t find writing comes naturally. One of the few good teachers at my school, Mr Palmer, did his best to encourage us, with promises that the more we read, the easier the words would flow. Well, Barry, do you mind if I call you Barry? I can honestly say that I’ve kept my side of the bargain. This year, I’ve enjoyed everything from Steig Larsson to John Steinbeck, by way of a very disturbing time with Aldous Huxley, but their extraordinary talent is yet to rub off. However, you did foster in me a love of reading, and maybe that was the point all along. It’s too easy to focus on the destination, when there’s so much pleasure to be gained from the journey. Anyway, we’ve got off the subject; this blog isn’t about writing.
The Year Without Amitriptyline
I expected it to be tough, but thankfully, I hadn’t realised quite how unpleasant it would be. The withdrawal has changed over the past year. At the beginning, there were a host of symptoms, so many it would be easier to count the parts of me not affected – I made a bit of a list in My Head Hurts #4.
On reflection, it should have been obvious quite how significantly antidepressants affect brain chemistry; after all, that is what they’re designed to do. The brain is the most complicated organism we’re aware of. One article I read suggested that the human brain is beyond human understanding, which ironically is difficult to get your head around.
In another life, I’d have found it a fascinating subject to study. It also makes me understand why researchers studying psychedelics are so tempted to try them; there’s nothing like experiencing the effect of your work from the inside.
“What if some of these effects aren’t withdrawal from Amitriptyline, but side-effects from the Fluoxetine?’“
A Change in Withdrawal Symptoms
My withdrawal symptoms are now less varied. I still have mild flu symptoms and the same histamine response, but both are less severe than they were. What has changed and become far more difficult to deal with is the nerve pain. When I first started tapering Amitriptyline (and taking Fluoxetine – more of that later), in November 2024, the first symptoms were pins and needles in my feet.
At the time it wasn’t much more than an annoyance; the weather was cold, and I assumed it was just one of the many pleasures of getting older! It didn’t take long for the pins and needles to become numbness, and then an ache. At some point, the ache turned into pain that extended to my hands, arms and then my shoulders, where it’s settled ever since. When it’s bad, it’s really bad; my legs feel as though they’re immersed in a bath of scalding water from which there is no escape.
The Fluoxetine Question
All science students are taught to avoid changing two independent variables at the same time; otherwise, it’s impossible to tell which is causing the effect. Of course, a living, breathing patient is not a science experiment, so when I started tapering down the Amitriptyline, my GP prescribed a replacement dose of Fluoxetine (Prozac). It’s the accepted practice, although I’m unconvinced it benefits the patient long term.
This has left me with a question nagging away at the back of my well-medicated brain: What if some of these effects aren’t withdrawal from Amitriptyline, but side-effects from the Fluoxetine?’ In which case, no matter how long I wait, how many vegetables I eat each, and how many walks I go on, they’re unlikely ever to fade! So, how long is too long?
As I now understand, doctors are concerned that taking a patient off one antidepressant without a replacement ‘could’ cause a recurrence of the original symptoms. But I experienced my original symptoms over twenty years ago. It is now accepted that fewer people suffer from serious life-long anxiety or depression than once thought – some do, of course – but for most of us, these are reactions to specific life events. In hindsight, I have a fairly good idea what those events were, if anyone had had the time to investigate.
Researcher Dr Mark Horowitz explains this really well in one of his excellent Q&A videos. This isn’t the specific video I was looking for, however, 43:30 onwards covers similar ground. I’ll update this if I find the clip I had in mind.
So What Now?
For the time being, I’m going to stick with the plan. The professional advice says that the brain can often take longer than a year to recalibrate to the lack of an antidepressant, especially for someone who had been on the drug as long as I had. I could address my nagging question by tapering the Fluoxetine, but my gut feeling says now isn’t the right time.
As I’ve said before, I always feel some obligation to provide a glimmer of hope to anyone who’s on the same path. But as I look through this post, I have to admit it’s in short supply. All I can say is, hang on to the thought that it will get better, one day.
Take care, N.
Further Help
If you need to talk to someone and you’re in the UK or the Republic of Ireland, The Samaritans are there for you. If you’re outside of the UK, at a look at Befrienders Worldwide. Be kind to yourself.
Dr Mark Horowitz’s website offers the most practical, professional advice I’ve found online. The academic papers are impenetrable to the nonprofessional. But he has useful links to newspaper articles which explain things in layman’s terms. The UK mental health charity, Mind, is also a good resource.
