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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
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Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I had been diagnosed with general anxiety after withdrawal

Resolved Question:

I had been diagnosed with general anxiety after withdrawal from taking a supplement/plant called kratom for around 6 weeks for back pain. The plant has an opiate effect action but as it turns out it also has alkaloids which affect serotonin as well as some stimulant properties. The withdrawal was painful but after weeks left me with terrible inner restlessness and irritation. I couldn’t stop moving around and was working our 2 or 3 times a day to get any peace. I also had fast heart rate, adrenaline rushes, panicky feelings etc. Went to GP who diagnosed general anxiety and put me on sertraline. My symptoms got much worse and the restless and extremely uncomfortable feelings in my body and especially my legs got worse. I was told they were start up side effects and to increase the dosage which I did. Things kept getting worse. I did lots of my own research and was convinced that I had an akathisia reaction to stopping the Kratom and the sertraline was making things worse with the increase in serotonin being antagonistic to already decreased dopamine levels (related to akathisia). I convinced my doctor of this and have been slowly reducing sertraline dose although he wants me to stay on 50mg. He also prescribed procyclidine for the irritation. This helps the agitation and most anxiety related symptoms have calmed down but I am left with terrible back and leg pain. My muscles and joints are very stiff and I struggle to walk and need to take strong painkillers to relieve the internal muscle aches (very deep muscle pains and cramps). I was otherwise pretty healthy before this, don’t smoke or drink, workout 4 times per week eat healthy Wondering what to do next. What could be going on here? If this is still the effects of akathisia should I be looking to treat this with some sort of dopamine agonist? Should I see a neurologist and if so which area of speciality should I be looking for? Do I need some sort of scan? Thanks

Submitted: 3 years ago.
Category: Medical
Expert:  Shantal-Mod replied 3 years ago.
Hello,

I'm Shantal and I'm a moderator for this topic.

We have been working with the Experts to try to help you with your question. Sometimes it may take a bit of time to find the right fit.

I was checking to see if you had already found your answer or if you still need assistance from one of the Experts.

Please let me know if you wish to continue waiting or if you would like for us to close your question?

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Expert:  DrRussMD replied 3 years ago.
Hello
How long since you had the plant
Customer: replied 3 years ago.

Mid November 2013 so over 6 months ago.

Expert:  DrRussMD replied 3 years ago.
I don't see that still having any effects.
Have you had a rheumatology work up?
Customer: replied 3 years ago.

No its been far too long for this to have anything to do with withdrawal but its has triggered something off in my body which has possible been exacerbated with the SSRI Sertraline


 


I have had various blood tests and checks on thyroid, vitamin deficiencies etc and all clear.


 


Before I started the SSRI I was getting some relief using Rhodiola Rosea supplement.


 


I am very sure this is a neurotransmitter related problem, specifically dopamine related which is why the SSRI is doing more harm than good. I have been taking the sertraline for 12 weeks


 


 


 

Expert:  DrRussMD replied 3 years ago.
there is not a medical condition that does this, not in regular medicine.
And you have not ruled out inflammatory disease, muscle disease, joint disease, and so on.

You need an MD who can put your urine findings in this context.
You can find MDs with this training here.
www.functionalmedicine.org
see the find a practitioner list, upper right.
Use reply to let me know if you have further questions [click reply to expert].
Please do not forget a positive rating [hopefully you will click an excellent; or come back to ask me more as needed].
Customer: replied 3 years ago.
Relist: Incomplete answer.
Expert:  Dr. D. Love replied 3 years ago.
Could you clarify what is incomplete about the answer so that I can address your concerns?
What are all the medicines and doses you are currently taking?

Customer: replied 3 years ago.

Im looking for some input on the akathisia from a neurologist who understands and has treated this condition. I need advice on what to try next


 


I also want input on whether or not the SSRI is exacerbating my situation and if so what would the best course of action be.


 


Currently taking Kapake painkillers for the pain and discomfort in my back and legs (3x per day) and procyclidine 5mg twice per day to try to cut down akathisia effect. It works a little and reduced the need to constantly move but does not stop the pain and discomfort


 


I know dopamine agonists can be used to treat these symptoms but my GP seems reluctant to go down that route at the moment. I am also a little concerned that this could be early onset parkinsons symptoms

Expert:  Dr. D. Love replied 3 years ago.
I would be glad to discuss these issues, but I am not a Neurologist. This question sat in the Neurology category for 2 days without being addressed, which is why it was moved to the general medical category. If you would like me to address these questions, please let me know.

Customer: replied 3 years ago.

Thanks but your right I very much wanted to hear from a neurologist. Hopefully a moderator can get this back in the Neurology category and prompt a Neurologist for a response

Expert:  Dr. D. Love replied 3 years ago.
I will refer the question to a mederator.

Customer: replied 3 years ago.

Hi


 


Having waited days for a response from a neurologist I am getting nothing back. If you think you can offer some insights into my current predicament I would be happy to hear from you


 


Thanks


 

Expert:  Dr. D. Love replied 3 years ago.
There are several issues to consider in this situation.

The other expert is correct that there is no clinical evidence that a 6 week course of kratom will cause the problems that you describe, either as a primary effect or with withdrawal. It is certainly possible that someone can have a unique reaction to any drug or supplement, but there are no studies that have indicated such a reaction to this.

Akathisia certainly can occur as a symptom related to a separate condition, such as Parkinson disease and anxiety disorders.

All of the SSRIs, including the sertraline, can exacerbate akathisia. When taking a drug that can exacerbate akathisia, the decision of whether to stop the drug is dependent upon how much the drug is helping the problem for which it was prescribed. If the sertraline is being used to treat anxiety and is providing significant benefit in the relief of the anxiety, then the doctor may be hesitant to stop the sertraline. But if the drug is not providing much benefit, then the doctor will more commonly stop the drug and use a different drug for the anxiety, such as buspirone.

As for what doctor to see, you are correct that the appropriate specialist to see for consideration of whether Parkinson disease is present would be a Neurologist, and preferably a Neurologist that subspecializes in movement disorders, if available.

Regarding the pain, it may help to see a Pain Management specialist. In someone with pain such as you describe, a scan may be necessary, although the findings on exam would usually guide that decision. It also may be an option to use certain anti-seizure medicines that have been shown to help chronic pain, such as gabapentin or pregabalin.

If I can provide any clarification, please let me know.

Customer: replied 3 years ago.

Thanks for your very comprehensive response.


 


I do think the sertraline is making the akathisia worse and in fact the pain was no where near as intense until I started sertraline. Also before I started the sertraline I was trying to treat symptoms myself using supplements and herbs and I was getting some relief from Rhodiola Rose which has MAOI properties and known to have a greater effect on dopamine. Caffeine also strangely helps my pain symptoms and I have suspected for a while that its a dopamine related issue (akathisia is a dopamine related problem).


 


Do you think is would be worth trying a dopamine agonist (requip) or indeed switching from SSRI to a DRI like Bupropion.


 


I was also considering gabapentin or pregabalin for the pain but having read lots about both of these I am slightly unsure as I hear lots of feedback about short term success but fast tolerance, rising dosages and nasty discontinuation symptoms when stopping. Have you had success in prescribing these medications for pain ocnditions


 


Would appreciate any views on the above. I really just need to decide what to do/try next. I am seeing my GP tomorrow


 


Thanks again


 


 


 


 


 


 

Expert:  Dr. D. Love replied 3 years ago.
Whether a dopamine agonist would be appropriate would be guided by the evaluation by a Neurologist. Over the internet, I can say that it is an option that should be considered, but the Neurologist will be best able to say whether it should be done after the evaluation.

Buproprion also can cause or exacerbate akathisia. It is apparently not as bad as the SSRIs, but it also can do so.

I have had many patients that have had a good response to gabapentin and pregabalin without developing tolerance or discontinuation problems.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18461
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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