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What Causes Deep Burning Pain And Muscle Weakness After Discontinuing Latuda And Lithium?
Question: Dear Doctor:
I have a complicated history with medication. I was on 400mg Seroquel, 200 mg doxepin, 30 mg temazepam, .5 mg klonopin. I tapered the benzos. This was six months ago. I was switched to 15 mg zyprexa and stayed on 200 mg doxepin. They switched me back to 150 mg seroquel and doxepin. I was then hospitalized again and they dropped the doxepin cold turkey. They put me on 1350 mg lithium, 80 mg latuda, 1mg klonopin, 60 mg propanalol, and 100 mg seroquel. I have had all this happen in the course of 6 months. I am a mess. I dropped the lithium and latuda cold turkey after about a week. Now I am having severe neurological symptoms of deep burning pain and muscle weakness 24/7. I am really sick. More sick than I have ever been. I am suspicious that restarting the benzo is what is causing most of my problem but can't be sure due to all the med changes. I feel like I am going to die. I can't sleep much at all but the klonopin knocks me out for a while. I am getting sicker and sicker by the day and it corresponds to the last 5 drug cocktail that they put me on. Do you have any suggestions? I see my psych nurse tomorrow and and starting with a new GP exam on Monday for the pain issue. I am afraid of taking any meds at this time due to the intolerable risk of getting even sicker which would lead to suicide. Please Help!
XXXX
I have a complicated history with medication. I was on 400mg Seroquel, 200 mg doxepin, 30 mg temazepam, .5 mg klonopin. I tapered the benzos. This was six months ago. I was switched to 15 mg zyprexa and stayed on 200 mg doxepin. They switched me back to 150 mg seroquel and doxepin. I was then hospitalized again and they dropped the doxepin cold turkey. They put me on 1350 mg lithium, 80 mg latuda, 1mg klonopin, 60 mg propanalol, and 100 mg seroquel. I have had all this happen in the course of 6 months. I am a mess. I dropped the lithium and latuda cold turkey after about a week. Now I am having severe neurological symptoms of deep burning pain and muscle weakness 24/7. I am really sick. More sick than I have ever been. I am suspicious that restarting the benzo is what is causing most of my problem but can't be sure due to all the med changes. I feel like I am going to die. I can't sleep much at all but the klonopin knocks me out for a while. I am getting sicker and sicker by the day and it corresponds to the last 5 drug cocktail that they put me on. Do you have any suggestions? I see my psych nurse tomorrow and and starting with a new GP exam on Monday for the pain issue. I am afraid of taking any meds at this time due to the intolerable risk of getting even sicker which would lead to suicide. Please Help!
XXXX
Brief Answer:
adding neurontin should prove a good choice.
Detailed Answer:
Hello
Welcome to HCM.
I understand your concerns.
You have been taking several drugs in past including seroquel, doxepin, zyprexa, temazepam, klonopin, latuda and lithium.
Now you are experiencing symptoms like muscle weakness, burning pain, disturbed sleep.
In my opinion, the sudden withdrawal of drugs and rapid changing to another medicines is the primary reason for your symptoms.
Klonopin 1mg is not a very high dose to cause muscle weakness and pain.
I would also opine to start with neurontin.
But I not in favour of doxepin as it would again be difficult to get off it due to withdrawals.
The thing which I am unable to understand is the reason for which so much drugs were started and why those were stopped/changed abruptly.
Was it anxiety or depression or psychosis???
If I would have been you treating doctor, I would just add neurontin to your current drug regime and think of withdrawing klonopin slowly with time.
I follow the principle of 'minimum drugs with maximum benefits'.
Kindly discuss this with your doctor.
Hope I have addresses your concerns satisfactorily.
Take care.
Thanks.
adding neurontin should prove a good choice.
Detailed Answer:
Hello
Welcome to HCM.
I understand your concerns.
You have been taking several drugs in past including seroquel, doxepin, zyprexa, temazepam, klonopin, latuda and lithium.
Now you are experiencing symptoms like muscle weakness, burning pain, disturbed sleep.
In my opinion, the sudden withdrawal of drugs and rapid changing to another medicines is the primary reason for your symptoms.
Klonopin 1mg is not a very high dose to cause muscle weakness and pain.
I would also opine to start with neurontin.
But I not in favour of doxepin as it would again be difficult to get off it due to withdrawals.
The thing which I am unable to understand is the reason for which so much drugs were started and why those were stopped/changed abruptly.
Was it anxiety or depression or psychosis???
If I would have been you treating doctor, I would just add neurontin to your current drug regime and think of withdrawing klonopin slowly with time.
I follow the principle of 'minimum drugs with maximum benefits'.
Kindly discuss this with your doctor.
Hope I have addresses your concerns satisfactorily.
Take care.
Thanks.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Dr Mehta:
I have been hospitalized three times in the last six months for very bad insomnia and suicidality. This has resulted in all these medication changes. None of the doctors seem to know the importance of slowly tapering the drugs. I am in a very unfortunate situation of having been taken off and on drugs abruptly due to the hospital stays which were not long enough to really stabilize me. I have been diagnosed as having depression without psychosis for years but suddenly the last psychiatrist labelled me "bipolar" and put me on a multidrug cocktail. I am now terrified to go to the ER because I don't want to go into that terrible hospital where they are under insurance constraints to quickly put people on pills and discharge them abruptly. I really doubt the resent diagnosis of bipolar since I have always been diagnosed with major depression. Another psychiatrist at the same hospital diagnosed me a few months ago with Major Depression without psychosis. I don't really know who to believe at this point. Will the symptoms subside or are they permanent? Thank you.
XXXX
I have been hospitalized three times in the last six months for very bad insomnia and suicidality. This has resulted in all these medication changes. None of the doctors seem to know the importance of slowly tapering the drugs. I am in a very unfortunate situation of having been taken off and on drugs abruptly due to the hospital stays which were not long enough to really stabilize me. I have been diagnosed as having depression without psychosis for years but suddenly the last psychiatrist labelled me "bipolar" and put me on a multidrug cocktail. I am now terrified to go to the ER because I don't want to go into that terrible hospital where they are under insurance constraints to quickly put people on pills and discharge them abruptly. I really doubt the resent diagnosis of bipolar since I have always been diagnosed with major depression. Another psychiatrist at the same hospital diagnosed me a few months ago with Major Depression without psychosis. I don't really know who to believe at this point. Will the symptoms subside or are they permanent? Thank you.
XXXX
Brief Answer:
choice of right drug is very important.
Detailed Answer:
Dear XXXXXXX
The diagnosis depends solely on history and mental status examination.
Unfortunately, your diagnosis has never confirmed by your doctors and you been given unnecessary drugs.
If you talk about symptoms of depression, they might disappear. But it depends on the respone to drugs.
If you are talking about the withdrawal symptoms due to abrupt stopping of drugs, they will disappear provided your doctor carefully increase/decrease the dose of your drugs.
At present, neurontin should prove good choice for you in insomnia and muscle pain.
Take good diet and plenty of water.
Hope this helps
Thanks.
choice of right drug is very important.
Detailed Answer:
Dear XXXXXXX
The diagnosis depends solely on history and mental status examination.
Unfortunately, your diagnosis has never confirmed by your doctors and you been given unnecessary drugs.
If you talk about symptoms of depression, they might disappear. But it depends on the respone to drugs.
If you are talking about the withdrawal symptoms due to abrupt stopping of drugs, they will disappear provided your doctor carefully increase/decrease the dose of your drugs.
At present, neurontin should prove good choice for you in insomnia and muscle pain.
Take good diet and plenty of water.
Hope this helps
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Mehta:
Thank you and I understand that I need a thorough medical assessment. It is unfortunate that I have had conflicting diagnoses. My follow up nurse practitioner is somewhat at a loss as to what drugs to put me on. She suggested one option would be neurontin (gabapentin). I am concerned about this drug a little bit because I have heard that it can be difficult to withdrawal from as well. I presume it acts on the gaba receptors in similar fashion to benzodiazepines. I don't want to trade one addiction for another so I hesitated. As to the other concerns. it is hard to know if and which drugs I should go back on since there have been so many changes. I was on Seroquel and stable on that in combination with other meds for a time. However, it no longer helps with sleep. I am at the point where I would like to taper off all medications safely, but I should stabilize on something first which unfortunately has not happened for a long time. I am afraid of neuroleptics and I am wondering that if I just do nothing perhaps with time the symptoms will improve. I have had multiple traumatic experiences with benzodiazepines which should be used short term and I have been kept on them far too long in the past. I thank you for your opinion. I am a very unfortunate and complicated case. I did the best for the longest on antidepressants when I first had depression 18 years ago until neuroleptic medication was added. This is when things went downhill for me.
Sincerely,
XXXX
Thank you and I understand that I need a thorough medical assessment. It is unfortunate that I have had conflicting diagnoses. My follow up nurse practitioner is somewhat at a loss as to what drugs to put me on. She suggested one option would be neurontin (gabapentin). I am concerned about this drug a little bit because I have heard that it can be difficult to withdrawal from as well. I presume it acts on the gaba receptors in similar fashion to benzodiazepines. I don't want to trade one addiction for another so I hesitated. As to the other concerns. it is hard to know if and which drugs I should go back on since there have been so many changes. I was on Seroquel and stable on that in combination with other meds for a time. However, it no longer helps with sleep. I am at the point where I would like to taper off all medications safely, but I should stabilize on something first which unfortunately has not happened for a long time. I am afraid of neuroleptics and I am wondering that if I just do nothing perhaps with time the symptoms will improve. I have had multiple traumatic experiences with benzodiazepines which should be used short term and I have been kept on them far too long in the past. I thank you for your opinion. I am a very unfortunate and complicated case. I did the best for the longest on antidepressants when I first had depression 18 years ago until neuroleptic medication was added. This is when things went downhill for me.
Sincerely,
XXXX
Brief Answer:
neurontin and benzos have different actions.
Detailed Answer:
Dear XXXXXXX
sorry for the late response.
Gabapentin and benzos have different mechanism of actions and gabapentin is not considered to be addictive. It is much safe then benzos in this aspect.
Considering its broad spetrum of action as a sedative, anti-anxiety, mood stabilising drug, I support its usage in your case.
Seroquel is well-known to cause withdrawal symptoms.
I think you can titrate the doses of gabapentin upwards till yu are stabilised on it.
The maximum dose of it is as high as 1800mg.
Withdrawal symptoms may improve with time but there is always a risk of relapse of depression.
You are currently on three medications which you listed to be propranolol, klonopin and seroquel.
The easiet to get off is propranolol, if its not helping you.
the second should be seroquel in my opinion as neuroleptics have worsened your condition.
Gradually, you should be stable on neurontin and an antideprssant which you have not used in past or which worked well for you in past.
Kindly discuss this with your doctor.
hope this helps.
I wish you well.
Kindly close the discussion if you have no more queries.
Thanks.
neurontin and benzos have different actions.
Detailed Answer:
Dear XXXXXXX
sorry for the late response.
Gabapentin and benzos have different mechanism of actions and gabapentin is not considered to be addictive. It is much safe then benzos in this aspect.
Considering its broad spetrum of action as a sedative, anti-anxiety, mood stabilising drug, I support its usage in your case.
Seroquel is well-known to cause withdrawal symptoms.
I think you can titrate the doses of gabapentin upwards till yu are stabilised on it.
The maximum dose of it is as high as 1800mg.
Withdrawal symptoms may improve with time but there is always a risk of relapse of depression.
You are currently on three medications which you listed to be propranolol, klonopin and seroquel.
The easiet to get off is propranolol, if its not helping you.
the second should be seroquel in my opinion as neuroleptics have worsened your condition.
Gradually, you should be stable on neurontin and an antideprssant which you have not used in past or which worked well for you in past.
Kindly discuss this with your doctor.
hope this helps.
I wish you well.
Kindly close the discussion if you have no more queries.
Thanks.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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