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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54184
Experience:  GP in the United States
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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?
I am concerned these may be early onset Parkinson symptoms
Thanks
Submitted: 2 years ago.
Category: Medical
Expert:  Shantal-Mod replied 2 years ago.
Hello,

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

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Expert:  Dr. K. replied 2 years ago.
Hello there. Kratom is an opiod, while its legal in the US, its illegal in Thailand for example. It has the same effect as heroin so you are suffering a severe withdrawal syndrome.

The muscle aches are similar to heroin withdrawal and nothing serious. You should use Advil or Alleve and start a daily vitamin along with extra calcium.

Seeing a neurologist may not help much but could set your mind at ease that there has been no lasting harm done.

There is no scan that can be done, as these are withdrawal and toxicity symptoms. They will go away on their own.

Heres a link you can read to put it all in perspective. I hope this helps.
http://usnews.nbcnews.com/_news/2012/03/19/10760892-asian-leaf-kratom-making-presence-felt-in-us-emergency-rooms
Customer: replied 2 years ago.

Although having an opiate related action Kratom is not technically an opiate and more comparable to something like codeine as opposed to heroin when it comes to effect, dependance and withdrawal.


 


I only took it for 6 weeks and had my last dose 6 months ago. This is definitely not related to any sort of withdrawal.


 


As explained in my question I have been diagnosed as suffering from akathisia and much of my question was related to advice on how to overcome this.


 


I did not find your response to be relevant enough to my question

Expert:  Dr. K. replied 2 years ago.
I am going to opt out, as you rated bad service without even giving me a chance to reply to you. Your original question does not specify the 6 month time interval. Good luck.
Expert:  Dr. Phil, MD replied 2 years ago.
still need help?
Customer: replied 2 years ago.

yes

Expert:  Dr. Phil, MD replied 2 years ago.
Did you suffer anxiety before you used kratom?
Customer: replied 2 years ago.

No

Expert:  Dr. Phil, MD replied 2 years ago.
I think the Kratom has triggered an anxiety disorder in you

This does happen. Drug use (which this would be essentially the neurological equivalent of) can often trigger underlying mental health disorders

I totally agree that this is an anxiety disorder.

This is not early onset Parkinson or akisthesia.

I think you need a higher dose of SSRI actually
Customer: replied 2 years ago.

Thansk for your response


 


I completely agree that withdrawal from Kratom triggered an anxiety dissorder. I had classic anxiety symptoms but these have pretty much all gone now probbaly due to the SSRI.


 


The problem is I am left with this muscle & joint pain and stiffness which is really quite extreme.I am struggling to walk arouns the house at certain times of the day when its at its worst (and I was running marathons last year)


 


I know anxiety can be the cause of muscle tension but the pain is too extreme for this and with the other anxiety symptoms gone I dont feel that this pain is anxiety related. My Doctor who like yourself was convinced it was all anxiety realted has also agreed that the pain seems to severe for this.


 


Just trying to decide what to do/try next. I dont want to just stop the SSRI for obvious reasons but is it worth trying to switch to a tricyclic AD for pain relief as well as anti anxiety effect or look at adding somthing like gabapentin or pregabalin for the pain


 


Any input woudl be welcome


 

Expert:  Dr. Phil, MD replied 2 years ago.
Thanks for this follow up

I believe you have fibromyalgia

This is often associated with anxiety and is associated with joint pain and muscle stiffness

There is a drug that works better than the SSRI for pain and also is excellent for anxiety

It is called cymbalta (duloxetine). I believe this would treat both issues
Customer: replied 2 years ago.

Thanks, XXXXX XXXXX fibromyalgia was a possibility.


 


I am wary to go on an SSRI because of what I read about severe discontinuation syndrome but I guess I need to consider this as an option.


 


Do you think it would be more effective than somthing like amitriptyline. Have you had success prescribing cymbalta to patients and have you had patients struggle with withdrawal symptoms on cessation of the drug?


 

Expert:  Dr. Phil, MD replied 2 years ago.
Cymbalta is a combined serotonin and norepinephrine drug

It works amazingly well for anxiety and pain

I like it a lot.

sometimes I will use it with amitriptyline at night for sleep. I like this drug too

Please don't forget an excellent rating when satisfied. I appreciate it
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54184
Experience: GP in the United States
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