Psycho-Babble Medication Thread 999903

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TCA toxicity but feeling much better. Do I stay?

Posted by hyperfocus on October 16, 2011, at 14:21:29

I had a very scary episode this morning - probably the first time I thought seriously about my own mortality and how it might come to an end right now. About 2 hrs after I got up the symptoms kicked in: I felt jumpy but confused; I felt extreme agitation but every time I got up I had to lie down again; My skin was hot and my heart felt like it was racing; my ears were buzzing and I kept seeing the color green on the white kitchen tiles; I had a strange cough and felt like I was choking. The most frightening thing was the inability to eat or swallow. I tried eating some bread but I could barely get anything down. it was like my throat and mouth stopped working.

I thought for sure it was extremely low blood pressure since I'd had something like this happen once before. But my brother who has some paramedic training said my blood pressure was actually high and I didn't have any signs of shock - my pupils weren't dilated and my skin wasn't cold. That's when I remembered what the symptoms of TCA toxicity were.

For the past week I've been getting a robust therapeutic response to 600 mg amitriptyline. That's twice what the max dose is supposed to be and 200mg more than the absolute max dose given rarely at hospitals. TCAs (apparently) have a very narrow gap between the max therapeutic dose and toxicity. But I had plateaued with my response at 300 mg amitrip for a while now and I really wanted to see how far I could push the dose and continue the improvements. So after a day on 400mg and another on 500mg with some success, I decided to swing for it and started at 600mg. I read that the minimum acute dosage that would cause toxicity and be considered as an overdose was 750mg. So I figured I would be safe as long as I stayed well below that. What I stupidly didn't realize is that chronic administration of 600mg over a week would build the drug levels in your blood quite quickly to the equivalent of a single 750mg dose and quite possibly much more.

Amitriptyline is a Alpha-1 adrenergic receptor blocker and a sodium channel blocker. I don't know what those things mean except that it makes amitriptyline cardiotoxic at high dosages.

So basically I had an inadvertent moderate overdose. Once I realized what was happening I sort of relaxed and didn't worry about it. I'm scared of something sudden happening in my heart while I'm sleeping though. On the other hand I've tolerated high-dose amitrip for quite a number of years. It's possible my body might adjust to these higher doses.

So the 2 choices I have are:
I. Stay on the 600 mg and hope my body adjusts itself to the high dosages
II. Cut back to something like 450 mg and hope I don't cut back on the therapeutic response.


The funniest thing about all this is how good I felt this morning while scared out of my wits and feeling like I was veering on the brink of unconsciousness. I kept thinking to myself - please don't die, I'm feeling good.

 

Re: TCA toxicity but feeling much better. Do I stay?

Posted by jono_in_adelaide on October 16, 2011, at 18:35:28

In reply to TCA toxicity but feeling much better. Do I stay?, posted by hyperfocus on October 16, 2011, at 14:21:29

I'd at the very least call your doctor and ask him to do an ECG and give you a thorough physical examination, and to do a blood level of your amitriptyline.

It might be worth considering other antidepressant options, such as Zoloft plus Welbutrin, or Effexor plus Remeron if the ECG shows anything amis.

Call your doctor today and see what s/he has to say.

 

Re: TCA toxicity but feeling much better. Do I stay? hyperfocus

Posted by Chairman_MAO on October 16, 2011, at 18:37:21

In reply to TCA toxicity but feeling much better. Do I stay?, posted by hyperfocus on October 16, 2011, at 14:21:29

It's your body, but IMHO you're playing with fire.

There is probably another drug or combination of drugs you can use without this toxicity.

 

Re: TCA toxicity but feeling much better. Do I stay?

Posted by Phillipa on October 16, 2011, at 19:27:01

In reply to Re: TCA toxicity but feeling much better. Do I stay? hyperfocus, posted by Chairman_MAO on October 16, 2011, at 18:37:21

I definitely agree with other posters. Why would you consider staying at a dose that can kill you? Phillipa

 

Re: TCA toxicity but feeling much better. Do I stay?

Posted by linkadge on October 16, 2011, at 19:30:57

In reply to TCA toxicity but feeling much better. Do I stay?, posted by hyperfocus on October 16, 2011, at 14:21:29

600mg is way too much amitriptyline to take on a regular basis. Amitriptyline has been linked to sudden cardiac death (more so than the other TCA's)

I would start to question why this drug is helping you. The reuptake inhibition would probably max out at about 100mg. Perhaps you are benefitting from the calcium channel blockade or something. Try some magnesium.

Linkadge


 

Re: TCA toxicity but feeling much better. Do I stay?

Posted by JONO_IN_ADELAIDE on October 16, 2011, at 19:55:02

In reply to Re: TCA toxicity but feeling much better. Do I stay?, posted by linkadge on October 16, 2011, at 19:30:57

It is generaly accepted that 150mg per day is the minimum effective dose for endrogenous depression, with some people requiring upto 300 (usualy extremely ill hospitalised patients) but 600mg per day is way over the top.

Was a doctor prescribing this much, or were you taking this dose of your own volition?

I would stop the amitriptyline, and see your doctor today for an ECG, physical, blood level estimations and the discussion of alternatives

 

Re: TCA toxicity but feeling much better. Do I stay? hyperfocus

Posted by Chairman_MAO on October 16, 2011, at 20:54:24

In reply to TCA toxicity but feeling much better. Do I stay?, posted by hyperfocus on October 16, 2011, at 14:21:29

I'm going to put this another way: you are poisoning yourself. Is someone actually prescribing you this dose?

http://www.preskorn.com/columns/0003.html#fig2

You need a second opinion _now_.

 

Re: Thanks everybody

Posted by hyperfocus on October 16, 2011, at 22:15:02

In reply to TCA toxicity but feeling much better. Do I stay?, posted by hyperfocus on October 16, 2011, at 14:21:29

I really appreciate your concern and you sharing your knowledge with me. I'm not a reckless person, really. I think the last reckless thing I did was chewing 3 Lifesavers at the same time. Only reason I'm in this extreme situation is that like many Babblers, I am Just.So.Tired.Of.Being.Sick. Monotherapy with amitriptyline is the best I've come along the recovery path for the strange mix of symptoms I have. Like most Babblers I've been on the med merry-go-round for so many years: SSRIs, SNRIs, TCAs, APs, benzos, in various flavors and combinations. Today I felt good (apart from the whole cardiotoxicity leading to possible death thing.) The dissociation and depression and anxiety have improved a lot over the past two weeks as I bumped my dose up.

@jono_in_adelaide
I see my doctor next week but only for a refill. The last script he wrote was for 300mg. I was hoping that I would have success at a higher dose and he would just do my script for that amount. But obviously 600mg is way too high - I really didn't think this through. My relationship with him is sort of distant - I don't mean that he isn't interested in me but we have this tacit understanding that I'm the only one who can accurately gauge how I feel and the only one who can devote significant time to figuring out how to beat my illness. I'll have to tell him what happened but only if I can get a full appointment.

@Chairman_MAO
If I understand the chart correctly it means that there's not much to be gained taking a big dose of TCAs but such a dose can lead to cardiotoxicity? That's actually quite useful info. The thing is I really don't know why I feel better on higher doses. My doctor didn't have any input in me taking 600mg - it was just me experimenting. He'll probably yell at me when I tell him, but the truth is that stuff like this I expect to happen. I do take your point though about capping the dose.

@Phillipa
I know it's dangerous but the truth is my day-to-day functioning is not what I'd call living.

@Linkadge
Yeah the stuff with minerals and herbs etc. I never really tried. I should look at them if what I'm doing now doesn't pan out.

@all
So what I'm going to do is stay with a dose of 400 mg and evaluate it for a few weeks. It's a high dose but still on the charts. There's no point going higher if I get the same therapeutic effect so hopefully I won't have to. But thanks very much for your input and concern.

 

Re: TCA toxicity but feeling much better. Do I stay?

Posted by Peter Heuer on October 17, 2011, at 10:07:25

In reply to TCA toxicity but feeling much better. Do I stay?, posted by hyperfocus on October 16, 2011, at 14:21:29

Hi,

I can only say that 600 mg of amitriptyline is one hell of a dose.

I was on 50 mg of Elavil for many years. This medicine helped me to sleep.

I would never touch more than 100 mg a day of this drug.

Best regards,
Peter Heuer

 

Re: TCA toxicity but feeling much better. Do I stay?

Posted by Christ_empowered on October 17, 2011, at 10:18:58

In reply to Re: TCA toxicity but feeling much better. Do I stay?, posted by Peter Heuer on October 17, 2011, at 10:07:25

I'm not a big fan of drug cocktails, but then again--I don't like TCA overdoses, either. Can't you just add something? A low dose stimulant, some wellbutrin...anything except ramping it up to the death zone?

 

Re: TCA toxicity but feeling much better. Do I stay? hyperfocus

Posted by Phidippus on October 17, 2011, at 17:36:25

In reply to TCA toxicity but feeling much better. Do I stay?, posted by hyperfocus on October 16, 2011, at 14:21:29

All that for quick brush with death? You do not keep dosing at 600 mg. That's REALLY overdoing it. I mean, just how much more therapeutic response do you need? At 450 mg you'd probably at 90% benefit...and just to get an extra 5% you'd be willing to die?


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