Reasons of blurred vision and profuse sweating

After taking sertraline, I am getting blurred vision frequently. Sometimes cannot read the fine print and labels on the shopping items. Also cannot work long time seeing the laptop monitor. Also, I get muscle fasciculation or muscle twitch on my eyelids and sometimes on muscles around the eye.

From Wikipedia, I got the following information.

The iris contains two sets of muscles:

• a radial group for enlargement of the pupil (dilator pupillae)

• a circular group set to decrease pupil size on contraction (sphincter pupillae).

The muscles regulate the amount of light entering the eye. The sphincter pupillae is stimulated through muscarinic receptors by the parasympathetic nervous system. The dilator pupillae is stimulated through noradrenergic receptors by the sympathetic nervous system.

Alterations are produced by muscarinic antagonism in two muscles: inhibition of iris sphincter muscle causes mydriasis, while relaxation of ciliary muscle produces ciclopegia.

It may be possible that, sertraline might have decreased acetylcholine in the eye muscles possibly due to its increased dopaminergic activity. However, I did not observe this effect with bupropion. So, the another possibility is that sertraline might have decreased noradrenaline which might have caused the imbalance in eye accommodation. I also feel less sweating with sertraline which I did not observe with fluoxetine or bupropion. Hence, in my case, profuse sweating might be the due to increased noradrenaline levels and blurred vision is probably due to decreased noradrenaline levels. Further research is required on this.

Update on 6 October 2015:

Effect of folic acid and methylcobalamin

During the last few months, I was having blurred vision after lunch and even after mild exercises. I was not able to read fine print and medicine labels for most of the time. I was not able to see computer monitor for long time and work. I took folic acid 1.25 mg and methylcobalamin 250 microgram and vitamin C 500 mg for few days. This combination almost cured my blurred vision. Now, I am able to read fine print (but not very fine print in the medicine labels), see computer monitor for long time and work. No blurred vision. It appears that I may have some fault in the absorption or processing of folic acid or cobalamin. I need to explore it further. After taking methylcobalamin, my finger pain also reduced very much suggesting the fault in processing of cobalamin.

Effect of Sertraline

After stopping fluoxetine, even though I felt more energetic and less depressed, I felt more irritability and gasping for breath which affected my lecturing ability.

So, I checked with a doctor about this. The doctor prescribed sertraline 50 mg once daily along with asenapine 5 mg (sub lingual once daily) and olanzapine 10 mg once daily.

I started with sertraline first at the night time after dinner before going to bed. Initially for the few days, I felt good mood and energetic. So, I added asenapine 5 mg. I felt dizziness, slurred speech, heavy discomfort and internal unrest. So the next day, I stopped asenapine. I did not start with olanzapine because I was afraid  of extrapyramidal side effects, possible weight gain and risk of diabetes.

So, I decided to continue only with sertraline 50 mg once daily at the night. After 3-4 days, diarrhea occurred. Everyday, two times. Especially, after waking up in the morning, severe urgency to defecate occurred with unable to control feeling. However, this was not like normal diarrhea and somewhat different.  The diarrhea was difficult to tolerate especially during the working hours in the office. And also, some feelings of compulsory activity (eyesight following the lines of an object, eyesight following a symmetrical lines in an object) and internal unrest occurred.

So, I decided to reduce the dose to half tablet (~25 mg) and change the timing to morning. So, for the last two weeks, I took the half tablet in the morning. No diarrhea occurred the next day and no more diarrhea. And the compulsory feelings and internal unrest also got reduced much. However, after one week, sluggishness and slowness of mind happened. I was unable to motivate myself to do the things which I had planned earlier. I also had stomach bloating and sleep debt. I felt there is something wrong with the food I am taking. I used to take coffee with milk powder and sugar (3 cups of coffee per day, morning before breakfast, after lunch and in the evening around 7.30 pm). So, I decided to stop the milk powder. The next day, I felt more energetic, more clear minded, less stuttering during the lecture. I think, the milk peptides from the milk powder may increase the GABA levels and might have caused this. I need to check this for few more weeks.

Overall, the effect of sertraline can be summarized as follows:

	Sertraline 50 mg	Sertraline 25 mg
Effects on anxiety	Reduced general anxiety and reduced anxiety of stuttering	Reduced general anxiety and reduced anxiety of stuttering
Effects on depression	No low mood at all; very bright mood	No low mood but some lethargy is there
Effects on stuttering and voice	Mild stuttering; reduced loudness of voice; Unable to make a good lecture	Very mild stuttering; Able to deliver a good lecture; moderate loudness of voice < that achieved with fluoxetine
Effects on motivation	Good motivation	Reduced motivation with milk powder in coffee. After stopping the milk powder, the motivation seems to be slowly onsetting.
Effects on telephonic conversation	Vocal blocks happened, unable to ask questions	less vocal blocks and fairly smooth conversation
Effects on affection and social life	Very good affection towards the wife and children	Average affection towards wife and children. Seems to be improving after stopping the milk powder.
Effects on sleep	Slightly increased sleep duration; but after waking up felt energetic and motivated to engage in works	Slept for more hours; sleep debt occurred; not refreshing after waking up; seems to be improving after stopping the milk powder.
Effects on libido and sex	Increased libido and erections; no premature ejaculations	Decreased libido
Effects on eye vision	Blurred vision occurred especially when taking multivitamins Supradyn recharge	Not much blurred vision; seems to be improving after stopping the milk powder.
Effects on driving	Apparently no effect	Apparently no effect
Effects on body temperature and sweating	Felt less heat in the body; felt cold; Significantly reduced sweating	No feelings of coldness in the body; Significantly reduced sweating
Other effects	Internal unrest; Diarrhea	No diarrhea; no internal unrest

I need to monitor the motivation levels and quality of sleep after stopping the milk powder.

Update on 31/12/2012

Eyelid Twitching

After I stop the milk powder, my energy level increased and motivation levels became normal. However, my stuttering was there on and off. So, I tried, L-methylfolate 7.5 mg tablet in the night. After few days itself, my mood flattened. After two weeks, I developed eyelid twitching. Both my eyelids started twitching involuntarily. This twitching occurred during the wakeful period. During sleeping, it did not occur. It was really embarrassing while talking to others. During the twitching, the upper eyelid moved horizontally. Sometimes, lower eyelid also twitched horizontally. Then, I stopped taking sertraline and L-methylfolate. The eyelid twitching gradually reduced in another two weeks. I realized that it is the effect of L-methylfolate when combined with the sertraline and possibly due to the increased dopamine at the basal ganglia which controls the eyelid movement. During this time, I took Ginkgo Biloba extract and omega 3. After another two weeks, the twitching stopped completely. No more involuntary twitching happened.

Composition of Proviton Multivitamin capsules (with ginseng)

Composition of Proviton Multivitamin capsules:
 

Composition: Each softgel capsule contains		% USRDA
Ginseng IDB         Highly concentrated and standardised (by HPLC) Ginseng Extract IDB (made from the main roots of genuine Panax Ginseng C.A. Meyer)	50 mg
Vitamin A	5000iu	100
Vitamin D	400iu	100
Vitamin E	15iu	50
Thiamine HCI (B1)	12 mg	800
Riboflavin (B2)	5 mg	294
Pyridoxine HCI (B6)	5 mg	250
Cyanocobalamin (B12)	15 mcg	250
Ascorbic Acid	30 mg	50
Folic Acid	1.3 mg	325
Nicotinamide	25 mg	125
Biotin	0.06 mg	20
Calcium	40 mg	4
Copper	0.1 mg	5
Inositol	7.5 mg
Iodine	0.05 mg	33
Iron	5 mg	28
Lecithin	50 mg
LysineHCI	0.3 mg
Magnesium	2 mg	1
Manganese	0.33 mg	8
Phosphorus	18.5 mg	2
Potassium	5 mg
Zinc	0.9 mg	6

Potential advantages of Proviton Capsules: 

• Low vitamin E content (may not cause nonstutterable pause while speaking)
• Low copper levels (may not affect GABA/Dopamine system)
• Moderate amounts of Vitamin B6 (pyridoxine) (may not increase serotonin and dopamine excessively)

Potential disadvantages of Proviton Capsules:

• Contains high amount of folic acid (may increase stuttering)

Effect of Vitamin E

I took Vitamin E (250 IU; d-alpha-tocopherol 167.5 mg) in the morning for few days. I experienced severe headache for almost the whole day. However, I observed one strange effect. If I take vitamin E together with a boiled egg, then I did not get any headache.

Positive effects:

• Reduced anxiety
• Able to work continuously with focus and concentration without getting much tiredness and it was helpful for writing articles at one stretch.

Negative effects: 

• Stuttering was mild. However, mild vocal blocks were there during the conversation. The speech was easy to start but after talking for 10-15 minutes, suddenly I was stuck with a vocal block in which I was unable to produce any sound from my throat. I could not even stutter. This vocal block was similar to the one I observed with DL-phenylalanine.
• Severe headache on right side of my head (indicating dopamine deficiency)

This vocal block might be probably due to the low level of dopamine. There is a research paper supporting this hypothesis.

Lazzarini M, Salum C, Del Bel EA.

Combined treatment of ascorbic acid or alpha-tocopherol with dopamine receptor antagonist or nitric oxide synthase inhibitor potentiates cataleptic effect in mice.

Psychopharmacology (Berl). 2005 Aug;181(1):71-9. Epub 2005 Oct 15. 

Link between working memory, stress, anxiety, depression and stuttering

Working memory in human beings can be analogous to the computer RAM. More the RAM a computer has, faster the computer is. Having more RAM in a computer can help the computer to perform faster operations and multitasking. Similarly, availability of more working memory in humans will enable to do better multitasking at faster speeds.

For the past 4 days I am taking Ginkgo biloba 2500 mg extract. Also, I am walking 30 minutes everyday evening around 8 - 9 pm.

Composition:
Each capsule contains 50 mg of standardized extract (equivalent to 2500 mg of dry Ginkgo biloba leaves); contains 24% ginkgoflavonglycosides and 6% terpene lactones.

Positive effects:

• Good mood - really good mood with inflow of innate happiness
• Very less anxiety - anxiety was extremely less while speaking
• Almost no stuttering - very good fluency with more talkative nature; No anxiety while calling through phone.
• Increased libido - With good inflow of happiness, I am in a mood to look forward for sex. However, not strong erections.
• No headaches - really no headaches and my head is really very clear
• Able to get ready faster in the morning - around 1 hour to 1 hour 15 minutes. Before, it used to be 1 hour 30 minutes.
• My car driving speed increased tremendously. I am able to drive at 110-120km/h speed and at the same time enjoying music. (Earlier, whenever I accelerate to 110-120km/h speed, all my attention used to focus on driving and on the road. And also, I used to feel my adrenaline rush. Whenever car used to shake due to road imperfections, my adrenaline increased and all my attention focused on road and steering wheel). But, now, I am least bothered about the car shake and able to enjoy music. 2 days back, I was driving in the fast lane at 110-120km/h speed. I made 3 cars to change to slower lane to give me way, which were going in front of me. Such a tremendous speed of information processing never happened to me before while driving.
• Music is enjoyable very much.
• I have started watching movies also. Earlier, I lose patience in watching movies continuously.
• Able to make phone calls to relative without much stuttering and anxiety. This was not at all possible before. Earlier, I used to have fear of stuttering and anxiety of talking over phone. Due to this, I avoided calling my relatives which led to some misunderstanding amongst my relatives.  

Negative effects:

• More sleepy - sleeping time increased to 8-10 hours.
• Not very strong erections. But sustained increase in libido is observed. This libido seems to be linked with dopamine levels. Actually before taking this Ginkgo biloba, I was taking bupropion SR 150 mg for four days. Then I stopped it for 1 day. Then, the next day, I took this Gingko biloba. So, the residual bupropion remained in the body would have caused this increased libido possibly.

Neutral effects:

• Not significant increase in speed of working - but slightly increased motivation to remain in a task is observed. Still inertia to initiate the planned work is there.

Update on 27 June 2012:

• Today I had to chair a meeting. No anxiety was there. No gasping for breath occurred. No pronounced stuttering also occurred. However, I felt little bit of vocal blocks when try to speak. But, once I started, then there was no stuttering. In a meeting, whenever, I had to interrupt a talking person, I felt some vocal blocks. So, I kept quiet. Otherwise, my stuttering was manageable. I cracked some jokes also.

Effect of No drugs

After taking fluoxetine and supradyn recharge for about 6 months, I felt the following effects.

Positive effects:

• Less stuttering
• Overall good mood
• No depressive thoughts
• Almost no anxiety on any of the previously known anxiogenic circumstances

Negative effects:

• Motivation is significantly reduced
• Unable to motivate myself - need to plan well ahead to execute a simple task
• Concentration is reduced significantly - unable to remain in a task for longer period of time
• Affection towards the family members is reduced.
• Sore throats due to throat infection occurred every month and it spread to all family members. Here, the mechanism may be considered as follows. Fluoxetine has some opposing effects to the stress hormone cortisol in the body. When fluoxetine is taken at the night time, it may suppress the release of cortisol during the night time. Less cortisol means less anti-inflammatory effects in the body since cortisol is a steroid and has good anti-inflammatory property. While taking lectures, due to the loudness of voice and continuous speaking, throat muscles may get injured. This injury will heal normally if there is enough cortisol in the body. Since, fluoxetine suppressed the night time cortisol release, this injury may not heal during the night time thus making it prone to the harmful effects of tooth paste in the next morning. Also, there is a possibility of infection occurring. 

Although the positive effects of this combination (fluoxetine and supradyn recharge) is highly beneficial to me, the negative effects did affect my progress in my career and in my personal life.  Hence, I decided to try something different. I thought that this is the time to stop my treatment. So, I decided to stop fluoxetine and supradyn recharge completely. I devised a plan to stop these two drugs.

First, I stopped supradyn recharge only. I continued with fluoxetine 1 capsule at night. Initially for two weeks, I had few headaches due to low serotonin. So, I took 4 bananas (2/morning and 2/night) to replace supradyn recharge's pyridoxine HCl (5 mg). Because each banana contains approximately 0.5 mg of pyridoxine HCl. This helped me a lot not to feel any sudden depressive feelings. Slowly I reduced the number of bananas to 1 per day. During this time, I took ginger coffee also to relieve my headache. I took ginger coffee (1 cup in morning and 1 cup in evening) for almost 40 days. Ginger coffee was prepared by adding 1 teaspoonful (~5 ml) of ginger extract (prepared by squeezing cut pieces of ginger in a mortar and pestle) to regular coffee. Ginger coffee helped me a lot in avoiding paracetamol tablets for my headaches. Sometimes the headache disappeared within 10 minutes of taking ginger coffee.

After 4-6 weeks of stopping supradyn recharge, I stopped taking fluoxetine completely. No tapering of doses. This time also I was continuing my ginger coffee. Also, I took green tea in the night. Green tea has EGCG, which has good anti-anxiety effect. I think it enhances the GABA function. So, I could sleep well in the night without fluoxetine. This was really something great for me. So, I had good sleep. I could get up in morning with some refreshed mind and energy. I took green tea for 1-2 weeks. Then I stopped taking green tea also.

After these things, I did not feel any low mood, depressive thoughts and less motivation. I felt good mood, somewhat increased motivation, no head aches etc.

Positive effect of no drugs:

• Good mood
• Good energy
• No significant effect on stuttering - stuttering was there but since no anxiety was there, I could speak to some extent by using filler words like "something like that" "Actually" etc.
• Good improvement in concentration
• Good improvement in motivation
• Good bright night vision
• Apparently no effect on driving
• Libido - initially improved but later stabilized - but better than that observed with fluoxetine

Negative effects:

• Although no appreciable anxiety is there, gasping for breath while talking occurred - indicating oxidative stress
• Frequent dizziness spells - increased while taking non-dairy creamer and decreased while taking milk for coffee.
• Premature ejaculation

Then, I focused on my diet. Because, my last blood check up revealed that I had increased LDL cholesterol, decreased HDL cholesterol, increased total cholesterol and increased uric acid. I used to take more proteins like fish, eggs, chicken and mutton to maintain my neurotransmitter levels. This excessive protein intake might have led to increased levels of uric acid. So, I decided to reduce my protein intake.

I took only rice in the night time. I completely avoided any protein rich food like chicken or fish. Occasionally I took 1 egg. This gave me the following results. I restricted protein intake to my breakfast /lunch time.

Positive effect of no drugs:

• Good mood
• Good energy in the morning - I could get up early in the morning - No residual sleepy mood.
• No significant effect on stuttering - stuttering was there but since no anxiety was there, I could speak to some extent by using filler words like "something like that" "Actually" etc.
• Good improvement in concentration.
• Good improvement in motivation.

Now, since I have gasping for breath while talking, it seems to due to the oxidative stress in the body. So, I am trying some antioxidants like Vitamin E and Vitamin C.