Amitriptyline – Two Weeks In

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I have now been on amitriptyline for two weeks.  Well, I will take my 14th pill tonight.  It hasn’t been quite the upheaval that beginning fluoxetine was, but it has been an interesting time.

I’m on amitriptyline while my doctor is awaiting my blood results to rule out other things that can cause fatigue and muscle pain in a similar manner to fibromyalgia.  It’s used to treat both nerve pain and to improve sleep – sleep being one of the more important factors in determining your ambient pain levels during the day.  It succeeded on both counts!  With some … interesting effects.

The first morning after I began taking amitrip it felt like all my muscles were limp noodles.  Walking was an interesting experience.  My hips swung wide and I caught myself on my dresser, on door frames, on couches …  and it was hard just getting my toast from the plate to my mouth.  Nothing quite wanted to cooperate.

I felt a little spaced out.  Not as much of a space cadet as fluoxetine, fortunately.  I didn’t feel like I was permanently lightly high.  I just felt … lighter.  The physical effects of amitrip definitely contributed to the overall light feeling.  I also slept really well.  For the first week at least.

The second week was a bit rougher.  My sleep became more interrupted.  It was harder to fall asleep on the couch at 8.  It didn’t help that I had a lot more commitments in the evening that week, so I wasn’t able to relax for a bit before dozing off.  I started to feel flat, like I wanted to do nothing and be an amorphous blob again.  I began having difficulties concentrating, my words jumbled up.  I felt sluggish.  My body felt heavy, I was sore.  I still had limp noodle muscles first thing in the morning.

Last night (for reasons I’ll blog about later) I had one of the best sleeps I’ve had in a long while and I am now out of a state of pure exhaustion and into a place of just normal tiredness.  The sluggishness, difficulties concentrating, and issues with words were mainly a result of the fact that I was utterly knackered.  Getting some seriously good sleep took that extreme edge off, leaving me with a more normal tiredness I know how to deal with.

The amitrip still makes my muscles noodles, and it’s lovely, because when I wake up in the morning I am not stiff and in pain.  It leaves me a bit wobbly for a few hours, but that is getting better with the exercises my physio has given me for stability.  I am also definitely sleeping better, although not as well as I did during the first week.  I still wake up during the night, just not as frequently.  I also really notice when I have and haven’t slept well the night before – I notice a huge increase in ambient pain levels through my hips and legs and up my back when I’ve slept poorly.  The amitrip only does so much for the pain.

All in all, it’s been an okay couple of weeks.  I’m hoping things continue to improve now that I’m getting better sleep, and the sluggishness goes away the better rested I get.

When You’re Tired – Rest

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I have been a mix of not quite exhausted but very tired this last week, with a mixture of no particular reason and plenty of good reason.

Earlier this week my heart ran a marathon without me, leaving me at first puzzled, then panicked, resulting in an 8 hour stay in the emergency ward and the trauma of an attempted catheterisation.  Fortunately we all concluded that the likely reason for this was the amitriptyline, and I haven’t experienced tachycardia like that since.

It’s phenomenal just how much that utterly wipes you out.  I went straight back into work the next day, so I didn’t take the time to rest and recover.  Work has been quiet the last couple of months (which has been amazing), however we’ve just started picking up in the last week.  There was a seminar that has produced even more leads, so now we’re well and truly under the pump.  Things really kick off when it gets to spring.  Which is good, but also not so good.  I stay busy and I don’t get bored, but I expend a lot more energy during work hours and so need to rest more in the evenings and weekends.

Which is exactly what I’ve been doing.  I’ve been doing as little as humanly possible after work and feeding the menagerie, which basically involves lying on the couch and being sat on by a cat until I fall asleep.  I have to say, it does feel like the amitriptyline is helping – I’m able to get to sleep a lot quicker, and it feels less interrupted.  I still wake up to shuffle when I’m having a flare up and I’m uncomfortable, but I wake up less during the night overall.

It’s important to listen to your body and do what it’s telling you to do.  Right now it’s saying ‘rest, rest, relax’, so that’s exactly what I’m going to do for as long as that’s what my body is saying.

Adding Amitiptyline

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Yesterday my doctor undertook the ‘prod test’ for fibromyalgia.  I reacted to some of the control points (I’m not surprised, my muscles are always tight) and really reacted to enough of the fibro points that he’s sent me off for bloods to rule anything else out.

There’s one point, 2cm caudal to the femoral trochanter that he only had to brush against and I was howling.  The other side, he didn’t so much find it because he knew where it was but because I would start yelping when he got there.

The upside is he’s given me amitriptyline, which has been identified as better than placebo in some trials with regard to fibromyalgia pain.  I’m now on fluoxetine in the morning, and amitriptyline in the evening.  Because they interact, I have to be careful of serotonin syndrome, which is a very serious problem involving too much serotonin.  Fortunately I am almost always around someone who knows what I’m taking, which is so important while my body gets used to the new balance.

So far it’s made me very sleepy in the evening, which is great, because sleep was one of the big problems I have been having.  Fluoxetine is a stimulant and has really taken my easy sleeping days and turned them upside down.  Add the discomfort from fibromyalgia and you’ve got me waking up 5-6 times a night, and that does not make for a happy bunny in the morning.

In the mornings, however, moving is hard.  My muscles don’t quite want to work.  They’d much rather remain in a relaxed state.  My legs wish to retain their noodly ways.  My balance is a little off.  My brain is sluggish and prone to going completely blank.  My reaction times feel a bit slower.  It’s similar to how I felt when I first started fluoxetine, just quite a bit less severe, so I’m interested to see how this progresses.

I had my blood taken today for testing, which is never a fun experience.  I’m very not okay about needles.  They always hurt, the sensation makes me want to jump out of my skin, and I’ll occasionally faint.  Today was no different, although hooray, there was no fainting.  I warned them I’m a sometimes fainter and sometimes puker, and they were very good about putting me on a bed and using the tiniest needle, and keeping me talking all throughout to distract me.  It still hurt quite badly, I still went very fuzzy (and would have fainted if I hadn’t been horizontal), and the site is still incredibly tender.  Because my body has realised it’s been ‘injured’, the rest of the elbow has also flared up and become somewhat painful.  The joys of being tender, I suppose.

Now I just sit tight and wait for a few weeks.  I’ll hopefully know whether or not I likely have fibro by about this time next month.  In the meantime, I get to adjust to amitriptyline!

 

Sleep and Mental Health

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These are two things that are intrinsically linked.  The better quality sleep you have, the better your overall mental health.  And, typically, the better your overall mental health, the better quality sleep you have.

And yet sleep is often the most difficult thing to get in sufficient quantities or quality to maintain good mental health.  It’s often one of the first things affected.  Either you sleep more, or you sleep less.  Or the quality just goes to crap.  You’re able to track these things with sleep tracking apps (my favourite is Sleep Cycle, but that’s mainly because I used to use it years ago and I don’t like change) which give you a rough idea of how deeply you’ve slept, and the length of time you’ve slept.  Its main use is looking blearily at it first thing in the morning wondering why on earth I feel like absolute crap and seeing very little deep sleep and going ‘oh, okay, that’s why’.

There are things I’ve found to improve sleep quality and quantity.  One of them is dietary supplements.  I’ve found magnesium (taken at night – I don’t know if this actually has an affect) calms the nerves and allows better quality sleep over a long period of time.  Taking magnesium was the first step I took in my walk to wellness.  I’ve also just started taking sublingual B12 drops, so we’ll see if that helps the muscle fatigue and aches and resistance to relaxation that plagues me.

Other than those two, I’ve found that I am able to fall asleep on the couch (not nap, no, this is proper sleep) when I have Forensic Files on the TV at a very specific volume.  I apparently can no longer fall asleep in bed unless I have either the amazing human being or the amazing dog on / in the bed with me, so on evenings where amazing human being is doing his amazing human thing past my bedtime … I don’t go to bed.  I put Forensic Files on, flip my hood over my face, and fall asleep on the couch.  It works a lot better than trying to fall asleep in bed.  And, bonus, I know I can zonk out early if I need to catch up on a bit of sleep.

Sometimes when sleep is being insanely stubborn, I’ll fall back on guided meditation to put me to sleep.  It’s important to find the right guided meditation for you – some voices are going to agitate you, and aren’t going to sit right.  Others deliver it in the wrong way.  I prefer male voices, mainly because my ears are incredibly sensitive to treble, and I get very stressed when I’m trying to find something to soothe me and it just makes my ears hurt.

I’m not yet at the stage where I’m contemplating medication to help sleep, but I know of a lot of people who are, and who do.  It’s important to note that if you need that much help to get to sleep, you need that much help to get you to sleep.

And now it’s time to fall asleep to Forensic Files, because I slept like crap last night.