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Misc Do I have brain damage from seratonin syndrome/anti-cholinergic toxicity?

seventhcandle

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Joined
Oct 6, 2012
Messages
9
For about three years, I had taken a daily regimen of 100 mg Butterbur (a natural muscle relaxer and antihistamine), 100 mg 5-HTP (a natural precursor to serotonin), feverfew (for migraine), riboflavin, magnesium, coenzyme q10, fish oil, and source naturals wellness formula. I have not taken any prescription or OTC medication other than the occasional tylenol. I am 31 yrs old, was very active, with no major issues other than visual migraines and anxiety, up to this point.

I had a very stressful period in my life this summer and picked up some Unisom (doxylamine succinate) sleep tabs to help with sleep for a few nights. After taking it once, I felt out of it the next day, had some ringing in my ears, and some jerks in my ankles when trying to fall asleep. On the second dose, I remember waking up startled twice during the night (jumping out of bed), but it worked & put me to sleep. The next few nights I noticed I couldn't sleep at all because of some muscle twitching which I would only feel at night in my feet along with the ankle-jerking sleep starts. I took my last dose of Unisom a few days later and had a frightening experience where I woke up with tightness in my chest & shortness of breath for about 15-20 seconds, which went away. The muscle twitching had spread to my arms, shoulders, and upper legs and was a lot stronger. I threw away the Unisom and did not sleep for 7 straight nights. I tried valerian root, melatonin, hops, and other natural remedies, but nothing worked. I just could not fall asleep and the twitching was present during this whole time along with having myoclonic jerks at night in my knees and feet. I did finally manage to get some sleep, which was mostly deep sleep, although I still felt funny in the head and I was still twitching.

Then I hit another bad run of sleepless nights and on July 30, I took one 5mg pill of Zolpidem (Ambien), thinking it would just knock me out and allow me to sleep through the night. Instead, it gave me rapid heartbeat, anxiety, and increased my muscle twitching to my face, chest, and even butt. All existing muscle twitches became intensified.

I also noticed a strange clicking sensation behind my adam's apple in my throat when I move my neck...I can feel something popping there. I also developed severe IBS (have to use the restroom after every meal and sometimes up to 8 times a day), a very sensitive bladder, and severe depression with frequent suicidal thoughts.

My downward spiral began from the ambien. Although I never touched another sleeping pill, I immediately lost my ability to get deep sleep and would (for the 1st time in my life) wake up frequently from intense dreams. I tried supplementing with magnesium citrate and magnesium glycerinate, but they did nothing for me except worsen my IBS. I also developed a repetitive jerk in my neck that happened every night and other random shock-like sensations and jerking in other parts of my body.

I also seemingly became hypersensitive to certain foods, lighting, and environmental triggers. For example, after eating a marshmallow one night I had a nasty round of all-night myoclonic jerking. And this jerking is BAD. It happens every night to some extent, but on the bad nights, I will get these jerks all over my body and in my face (tongue clicks, ear closes by itself) including some tremors. The same thing happened to me after eating a slice of pizza and eating something with soybean oil in it. I can't go into grocery or department stores because of the lighting.

I took a 100 mg l-theanine supplement in August, thinking it might help with the twitching and jerking, but it just made things worse and gave me new, more intense twitches and new myoclonic jerks including another one in my neck where it bobs up and down at night in addition to the left and right. I also discontinued my migraine supplements at that time for fear that I may have had a prolonged version of serotonin syndrome or anticholinergic toxicity.

Ever since then, things have been going downhill rapidly. I twitch everywhere (head to toe, including tongue) all day long and at night the twitching is intense enough to make it difficult to fall asleep. I also get powerful twitching in my fingers and toes. And as if that isn't bad enough, I get those darned myoclonic jerks every night. If I encounter a trigger during the day (weird as they all are...food, lighting, etc.) I will usually not get any sleep for 2 straight nights because of all night jerking and the twitching also permanently intensifies along with that.

My dilemma is all of this got really, really bad after one 5mg zolpidem pill. How is this possible? I feel like I may have some kind of permanent brain damage and I have no idea what to do about it. My sleep quality is terrible. When I do manage to fall asleep, I always wake up 1-4 hours later feeling exhausted. The sleep is very dreamy, almost as if I've lost my ability to get deep sleep. And my legs cramp every morning from all the twitching. The twitching is so severe now that it actually hurts when I twitch and I twitch at least once every few seconds all day and night. I've also started getting intermittent sharp pains (almost headache-like) in my right temple and both sides of my forehead.

I am a married man who has to support his family. My wife cannot work and my son is only 5. I have been prescribed klonopin, mirapex, and neurontin, but I have sweated it out with nothing at all (not even herbal) hoping my symptoms would get better on there own. It's been over 2 months since my one and only ambien and I feel like a walking dead person.

I feel like things aren't getting better and the doctors don't know what to say either. My situation is obviously unique, but shares some similarities with benzo withdrawal in the sense that my really vicious, debilitating symptoms began after one dose of zolpidem.

God, if there is anyone out there who can relate or provide some insight into what's going on, I would be very grateful. I am depressed, lonely, and feel like I'm dying. Nobody around me understands the daily hell living has become. Thank you.
 
Do I have brain damage from seratonin syndrome/anti-cholinergic toxicity?

No.

It sounds like you just don't respond well to either benzodiazepine-like agents or anticholinergic drugs like doxylamine.
Paradoxical reactions to benzodiazepines and the Z-drugs are well known. It's not unusual for some individuals to have horrifying hallucinations and become incredibly restless and agitated from the use of e.g. Valium. Ambien is closely related and is sometimes abused as a recreational drug, so I'm sure it could have wierd side effects.

Muscle and leg twitching is also a known side effect of antihistamine anticholinergics, like doxylamine and diphenhydramine, especially in large doses.

Neither of these drugs should produce long-lasting effects so you're either:
1. stressing yoursdelf to the point where you've created stress induced symptoms like IBS et cetera
2. you have some other underlying condition. If you were previously on Klonopin (esp. higher doses, 2+mg a day) and recently have discontinued it that may adversely effect your sleep quality as well - you should titrate downwards with benzos, never cold-turkey them...

Try taking a day off to unwind. Have a hot bath, go get a massage or something. Scented oils like lavender, rosemary, heliotrope have all been proven to help reduce stress and increase cognitive performance - just the aromas. Herb teas are good, green tea is good too. Put the thought of permanent damage out of your mind. You obviously can hold your life together at this stage, so that's a sign that you can't be that terribly crippled. Another thing that will help considerably is excercise - moderate to strenuous. Go for a swim, go for a run, go play soccer or football or something. Get the blood flowing for a while and you will sleep quite a bit better. Excercise until you are tired and then have a hot shower and a light meal. You'll probably sleep like a brick.

Ambien/doxylamine do not produce brain damage from single or even multiple dose usage - only in the case of massive overdose. Doxylamine especially - if it caused permanent damage it would not be an OTC medication. Ambien is actually used to temporarily bring people out of comas...

"Serotonin syndorme" isn't even an option. It has no place here. Neither of the drugs you took have a major involvement with serotonin. Serotonin syndrome is not a moniker for "nonspecific, moderate-to-severe drug induced negative after efects".
 
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No.

It sounds like you just don't respond well to either benzodiazepine-like agents or anticholinergic drugs like doxylamine.
Paradoxical reactions to benzodiazepines and the Z-drugs are well known. It's not unusual for some individuals to have horrifying hallucinations and become incredibly restless and agitated from the use of e.g. Valium. Ambien is closely related and is sometimes abused as a recreational drug, so I'm sure it could have wierd side effects.

Muscle and leg twitching is also a known side effect of antihistamine anticholinergics, like doxylamine and diphenhydramine, especially in large doses.

Neither of these drugs should produce long-lasting effects so you're either stressing yoursdelf to the point where you've created stress induced symptoms like IBS et cetera, or you have some other underlyign condition. Ambien/doxylamine do not produce brain damage from single or even multiple dose usage - only in the case of massive overdose.

Thank you for the reply, but my question is more about the interaction between 5-HTP (100 mg), butterbur (100 mg), and doxylamine and the herbs and ambien. Could that have produced all of these lingering symptoms? I know the drugs themselves wouldn't cause any brain damage, but would these interactions possibly and the fact that I kept ignorantly taking the herbs before and after each dose?
 
5-HTP is essentially inactive if you are not on MAOIs or amino acid decarboxylase inhibitors.
Butterbur seems to be an anti-migraine/anti-hayfever treatment, but if improperly prepared may contain toxic liver damaging alkaloids. I would discontinue it personally - it doesn't seem to me that it has any real benefit over other herbal sedatives)
Doxylamine is a standard anticholinergic/antihistamine broad spectrum sedative drug, if anything it acts as a mild antipsychotic and should stabilise you. No action at benzodiazepine site, slight to moderate serotonin-blocking effects. (not blocking the release of 5ht, blocking serotonin's effect at postsynaptic receptors)
Ambien is a benzodiazepine-mimic with no action at other sites.

All of these have 4 different modes of action and should not produce anything more than simple additive effects.

Better herbal sedatives:
Lavender (oil, herb - especially the scent)
Valerian (root)
Chamomile (oil, flowers)
Lemon balm / Melissa officinalis (oil, leaves, stems, and flowers)
Cannabis indica (oil, flower tops, leaves)
Hops (oil, flower cones)
Green tea (extract, or decaffeinated - L-theanine is a good mild sedative)

Any of these in combination will probably be more effective than your current mixup.
 
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5-HTP is essentially inactive if you are not on MAOIs or amino acid decarboxylase inhibitors.
Butterbur seems to be an anti-migraine/anti-hayfever treatment, but if improperly prepared may contain toxic liver damaging alkaloids. I would discontinue it personally - it doesn't seem to me that it has any real benefit over other herbal sedatives)
Doxylamine is a standard anticholinergic/antihistamine broad spectrum sedative drug, if anything it acts as a mild antipsychotic and should stabilise you. No action at benzodiazepine site, slight to moderate serotonin-blocking effects. (not blocking the release of 5ht, blocking serotonin's effect at postsynaptic receptors)
Ambien is a benzodiazepine-mimic with no action at other sites.

All of these have 4 different modes of action and should not produce anything more than simple additive effects.

Better herbal sedatives:
Lavender (oil, herb - especially the scent)
Valerian (root)
Chamomile (oil, flowers)
Lemon balm / Melissa officinalis (oil, leaves, stems, and flowers)
Cannabis indica (oil, flower tops, leaves)
Hops (oil, flower cones)
Green tea (extract, or decaffeinated - L-theanine is a good mild sedative)

Any of these in combination will probably be more effective than your current mixup.

Ok, so you are saying that 5-HTP + Butterbur + Unisom and 5HTP + Butterbur + Ambien combinations (which I did a total of 3 times (for the Unisom) and 1 time (for the Ambien) could not possibly cause serotonin syndrome (since 5-HTP is known to increase serotonin levels and doxylamine also mildly increases them as well & since butterbur has mild anticholinergic effects and so does Unisom and Ambien).

I am just asking because my reaction to these meds (while I was on the supplements) has turned out to be quite severe.

I've never touched a benzo before in my life. Different neuros have prescribed me Klonopin, Mirapex, and Neurontin. I haven't taken any of these so far or any meds or herbs for that matter, other than a single instance of L-Theanine (which I had a paradoxical reaction to).

I discontinued all the herbs and supplements over a month ago and stopped taking all meds over two months ago, so I do not understand why my constant twitching has worsened, become more widespread, and intense to the point where it hurts when I twitch. And then the muscle jerking at night (prior to sleep onset) is super-awful and I have no control over it (it even happens on my face). I am unable to nap during the day due to the twitches and jerks and it is difficult to fall asleep at night due to the painful twitching (my tongue, lips, forehead, neck even twitch...I mean, it's everywhere).

And while stress/anxiety certainly can make symptoms worse, there are some strange non-stress related triggers that happen to worsen symptoms (and when they worsen, they stay at that level permanently) including fluorescent lighting, certain foods with preservatives, certain cheeses, anything containing soy or MSG.

The only underlying condition I had prior to this medication reaction was migraine with aura. I was otherwise healthy and strong. Now I am so weak I can barely walk around, am at risk of losing my job, and alienating myself from my family.

The reason I suspected serotonin syndrome and/or anticholinergic toxicity as the culprit was because of the effects daily doses of 5-HTP and Butterbur may have had on my serotonin levels and the combined effect of Butterbur and Unisom/Ambien as an acetylcholine antagonist.

I also suspected these syndromes because I've never had IBS before, but now I suddenly have it very, very bad and this strange clicking/popping behind my Adam's apple happened almost instantaneously after my one and only dose of ambien.

I believe I've also had some mild seizures (woke up with several limbs flailing around and my eyes blinking uncontrollably) and I've had some strange sharp pains happening in my right temple and forehead area (like brief "ice-pick" pain sensations only lasting a few seconds).

So you think paradoxical reactions could cause all of this crap and that the combination of herbs/drugs is not to blame?
 
Have you been prescribed/tried any muscle relaxants? Those might help with the twitching and the sleeplessness.
I can see you have an aversion to prescription medication, but sometimes mugwort and dragon's entrails just won't cut it man.
Have you had an MRI scan/been seen to by a neurologist?

I'm very sorry for you, you sound desperate. This forum is full of helpful people so you've come to the right place (although a doctor's diagnosis - and taking the medication he gives you! - is better than any BL post could be).

I have been prescribed Mirapex, a muscle relaxer used to treat people with parkinson's, but I have not tried it as I am afraid of what it might do to be.

Surprisingly, none of my neuros has ordered an MRI, although I have an appt. with a movement disorders specialist this week, so I am going to bring that up.

So far, I have seen four neuros and all of them diagnosed me differently without being 100% sure about their diagnosis. I have been diagnosed with everything from benign cramp fasciculation syndrome (which I definitely have, but in a very severe form), periodic limb movements of wakefulness, restless legs syndrome (don't have that), and insomnia (well duh, lol). But my neuros usually don't really know what's going on and they just treat me like a medical mystery. They would say, "Well it seems you have PLMD, but those shocks and jolts you get in your face and tongue at night don't quite match up."

Some have said I may have had some degree of serotonin toxicity. Others have denied the possibility. But the bottom line is, nobody seems to know what's going on.
 
The reason you are so hard to diagnose is you present with a wide variety of seemingly unrelated symptoms that occured suddenly after a single dose of normally safe medication, and have been on a continuous downward slide ever since. That's not normal at all.

Either you are a hypochondriac or you have a severe tic disorder. I don't know. Symptomatic treatment is all you're going to get. I would bet tons of money on you having normal MRI/CT anyway.
 
OP no offence but you sound like a bit of a hypochondriac. Sekio's advice was excellent - take a break and chill out. There's no way you've given yourself brain damage (sekio put it in decisively more erudite terms, so I'd take more assurance from him than me lol).

I am a bit of a hypochondriac, I won't deny that. I will use some of his advice for sure and report back if it helps. Thank you for the info and I assume, as with benzo wd, that the brain heals itself with time.
 
as seiko says the best things to help would be a balanced diet and mostly moderate to heavy exercize. you should really work out till exaustion, and you will sleep better.
i suggest you to consider the possibility to use the benzos and muscle relaxant you have been prescribed. they are very effective medications with a long history of use and i sense that they could be right for your condition. obviously use great caution as these are very powerful meds, but if you say you are in living hell they are definitly worth a a try. never stop medications cold turkey but always taper them.

good luck dear, shall light be on your path!!
 
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