Need some advice, i am in a strange situation

[Bootlegger]

but all tied together
Hi, I have RRMS, been feeling like a flare for several months (yes, months).
Neuro of the country due to family emergency. He has been my only one since dx 9 yrs ago. He is specialist, head of dept in teaching school. I am unable to see ANYONE there till Dec. Made appt months ago. Just being told to go to ER. Have insurance but cant afford the copay for another neuro right now. So no neoru to consult.
My primary care dr, who really was great and took fantastic care of me moved to a new practice a few months ago that does not take my insurance.

I went to new Dr at where he was at, and wanted to document my ms issues and see about getting off of Cymbalta and then getting back to Zoloft. Cymbalta did nothing for my leg pains but made me a zombie. Been one for over a year. He wrote me a script for 100mg Zoloft (I was on 50 before, all in my chart there). Told me to stop Cymbalta right away and start Zoloft in morning.
Also wrote me amitriptyline to take at night INSTEAD of my well working Ambien. (well established for me that is what only works without side effects or sluggish next day.
Now for issues, stopped amitriptyline after 3 night and days and totally sleepiness. I knew I couldnt take rhat crap. Back to Ambien. That is fine. But been feeling not right emotionally, head inside feels weird. I asked him was it ok to stop the C and start the Z and he said it is fine. Well, not for my brain!

Does anyone here know from experience about the antidepressants like that? I am already stressed from a lot of home issues, the ms pain and super weakness and fatigue, can not think clearly.
Sorry so long, just wanted to tell why I feel like I am in a boat with no paddles.
Input?
I am on Aubagio 7mg. Figured Neuro wanted to go up to 14 mg, esp since i am feeling like this for months. But unable to speak to anyone there that can help me. Ugh?
Now think I am in a serious antidepressant , crap, cant even think of the word I need.
Anyone able to give me their input?

[KoKo]

Hi Bootlegger ~

It looks like you are going through a really rough time.

I'm sorry that your neuro is not available to help you, as it seems like you really need him at this time. And your PCP that you really liked has moved to a new practice, which doesn't help matters either.

I have no experience with any of the meds that you have mentioned, so I can't offer much help there.

I wonder if you could get on the cancellation list to see a neuro sooner?

In any case, hope you start feeling better soon.

Take Care

[Jules A]

You need a skilled PCP or preferrably psychiatrist to check out the abrupt discontinuation of Cymbalta and restarting of Zoloft at 100mg.

Hope you feel better soon.

[Myoak]

Hello Bootlegger,

Since you asked for input I will respond with the understanding that you fully realize my expression is my medically untrained opinion only. Okay?

First, you are on 7mg of Aubagio and have been since your first dose of it Oct. 18, 2017. I assume you are taking it once a day, correct? Of course, 14mg is the usual dose. So, your doctor started you out on 7mg and has not increased the dose to 14mg even one year later.

There must be a reason he has not increased the dose and the most likely reason, IMO, is tolerability. It is impossible for me to believe you are tolerating it well. And, that offers the distinct possibility Aubagio may not be a good med for you personally. Sarabeach's observations were spot on.

You stated you have been feeling for months as though you are having a flare. Is it possible that feeling be could coming from Aubagio? You have been taking it for months now. Flares don't usually last that long.

What if you stopped taking Aubagio for a couple of weeks to see if your health improved? It may be that you would feel much, much better. But that is only speculation.

Here is the deal... you would feel better or you would feel the same, or you would feel worse.

If you feel better... it was the med.

If you feel the same, is there a good reason to be taking it?

If you feel worse, the med was helping and you can re-start it and perhaps, ask to be bumped up to normal dose of 14mg.

In addition to how you feel... wouldn't it be great to do a 25 foot timed (stopwatch) walk and a 9-Hole Peg Test while on Aubagio and then again after two weeks or more off of it and compare the results? I bet you could do the 25' timed walk with someone timing you.

It is only my untrained opinion but my guess is that the medicine is making you feel the way you do.

Please, let us know how things are going, won't you?

Best wishes! Hang in there!

[pennstater]

Can you call the PCP and let him know what you're experiencing? You may need to wean off it. I did read about 50% need to wean off as opposed to cold turkey.

From drugs.com:
Minor withdrawal symptoms include nausea, headache and dizziness. Severe symptoms include seizures, nightmares and electrical shock sensations (described by some as "zaps" around your body, which may be paresthesias).

Hope you are feeling better.

[trevvian]

Not a doctor and I can't speak to the Aubagio, but I have been on Zoloft, Cymbalta and Amitriptyline.

Cymbalta, I had to taper off. I felt restless and twitchy, like someone puffed hot air into my head.

I almost wonder if that abrupt cecessation of both that and Ambien could cause the sleeplessness.

Why did he replace Ambien with Amitriptyline? Amitriptyline isn't exactly a sleeping pill, though some use it that way.

Seems like a lot of quick changes for meds that typically titrate up or down. I'd give him a call back.

I'm sorry your insurance sucks. I can't imagine how frustrating it must be not to be able to pick whatever doctor you want.

[Jules A]

Ambien isn't meant to be used long term and with abrupt discontinuation after long term use it isn't unusual to have significant rebound insomnia. Also unfortunately I still see it prescribed above the maximum recommended 5mg for females. Not that there aren't instances where the maximum recommended dose of medications are exceeded but it needs to be done in a thoughtful manner with a skilled prescribernwhich often isn't the case, imo.