Hi all, I'm hoping for some advice and viewpoints on my situation. For clarity, I'm talking about glutamate as a neurotransmitter, not as MSG (which I've seen come up a bit).

I'm a 28 year old male. Had a binge drinking problem for a few years now. I would drink heavily on the weekends, but never during the week. Last year I finally started to get a handle on it and drastically cut my alcohol intake. I was down to once or twice a month, and before all this happened I hadn't had a drink for 6 weeks.

End of May I went out with some work colleagues on a Friday and had a lot to drink. Next day was normal, just a standard hangover. However, it was a Bank Holiday on the Monday and therefore I didn't need to work. Stupidly I drank again Sunday night, more than on Friday and in a shorter space of time. The following week was sheer hell as I went through an acute alcohol withdrawal. Severe tingling headache all week, massive anxiety, insomnia, shaking, sweating, rapid pulse. About the only thing it stopped short of was seizures and DTs.

I went to the doctor about it on the Friday and she took my blood pressure etc. At that point I was already over the worst of it so she didn't think it necessary to give me anything. I still had the splitting headache.

The headache has not stopped since then, and that was 5 months ago. It definitely has improved in terms of severity - the first few weeks it was very bad all the time, but it's more of a dull ache or "uncomfortableness" now, with occasional spikes. I've been back to the doctor multiple times following the first one and have seen 2 different GPs. Both diagnosed tension headache. I've had some parasthesias in my head along with the headache.

That was the story up until week before last. Following both doctors' advice of it being a tension headache and given that it had improved significantly and I hadn't developed any further symptoms, it seemed like they were right and I went out with a few friends on the Saturday (24th). Had quite a few beers, but nothing anywhere near what I used to drink. Also the only alcohol I'd had in 5 months. The headache was worse the next couple of days but I put that down to the alcohol exacerbating it. I didn't have the same withdrawal symptoms again - a bit of anxiety on the Monday but not even any insomnia (which I did used to get when I was drinking heavily).

Then Saturday just gone I started to get very worried because I felt a bit of tingling in my little fingers. This went away after a couple days. I also had a bit of tingling in my left big toe and once felt some stabbing pains there. I've been concerned about the possibility of the alcohol withdrawal causing nerve damage since it happened. Today I've been getting pinprick sensations all over my body and randomly. I've also noticed a bit of twitching/jerking and maybe slight tremor in my hands. Around lunchtime today I also think I had some tingling and warmth/burning in my left foot. Ironically today has probably been the best day for the headache since it started.

Naturally I am now extremely concerned that this is neuropathic pain. My questions really are:

- I don't think any PN has been caused by the alcohol itself. I did not experience any of these symptoms until I went through the withdrawal. I had not had a drink for 6 weeks before then and I've always eaten well. From what I've read alcoholic neuropathy is caused by a combination of a chronic buildup of alcohol/acetylaldehyde and vitamin deficiency. I don't think a vitamin deficiency is very likely.

- Is it possible for the glutamate rebound from the alcohol withdrawal to cause neuropathy? I mentioned my concern about this to the doctor and he didn't seem to think it was a possibility. From what I've read the majority of glutamate in the system is in the brain itself. If the excess glutamate was causing damage shouldn't I also be experiencing cognitive issues with vision/balance/speech etc?

- I've suffered with anxiety for many years. This was discussed with the doctors and they put me on Sertraline (Zoloft). I've felt that it's helped with the social aspect but the possibility of the headache and now these parasthesias being neuropathy has basically been all I've thought about for the last 5 months. Is it possible that the anxiety of worrying about it and the stress caused by that and the withdrawal is causing the physical symptoms? Can these symptoms be psychosomatic and effectively created by my brain after my having read so much about it all?

- I found that aspirin was the most effective analgesic for the headache, which apparently is a known thing about tension headaches. I had to stop taking it though when I was put on the sertraline. What's the likelihood that the headache is PN if aspirin helps with it? I've read OTC painkillers are not effective against neuropathy.

- i'm not sure from reading whether transient parasthesias like I've been having are typical of PN. It seems like the tingling/burning sensations are usually constant, is that correct?

- Does the progression make any sense? From what I've read, PN typically progresses from burning/tingling in the hands/feet. I've had headache and parasthesias but not any burning or anything until today/this last week. I have no numbness or allodynia. If it was PN induced by the glutamate from the withdrawal shouldn't these symptoms have shown up sooner?

- I started taking a B12 supplement the last couple of days following advice on here. Can the B12 be causing the pricking sensations?

- Can I only expect it to get worse from here?

What I'm currently taking:

Sertraline 100mg
Vitamin D
Vitamin B1
Vitamin B12
Magnesium
Zinc
Coenzyme Q10
Acetyl L-Carnitine

I was taking a B complex but stopped because of the B6 in it.

If you managed to read through all that then thank you, it came out a lot longer than I expected.

Thanks for any help or advice you can offer.

Many of the symptoms of hangover...are due to ALDEHYDES building up in the body, from alcohol intoxication. Binge drinking is quite dangerous in this way, and also to the brain. Alcohol is a poison basically.

When you are not drinking there is no overload on the dehydrogenases (that thiamine B1 is part of.) But if you binge after a long dry period, the enzymes are not plentiful enough and the hangover, is much longer and more painful.

Many people find after giving up alcohol, that a slip, and have just one drink can make them ill, or give tingling with the nerves called paresthesia.

When did you start the Zoloft? It can cause all sorts of problems in some people.

What type of magnesium are you using? If it is Oxide form, that has to be changed to a version that is actually absorbed from the GI tract. How much thiamine do you take? Is it benfotiamine form? I hope you are taking methylcobalamin form for B12, and on an empty stomach.

I am having a difficult time understanding your use of "alcohol withdrawal" as a term. Stopping drinking of short duration should not give a "withdrawal". When you stopped initially in the beginning, that is when a "withdrawal" comes. Binge drinkers do not typically get withdrawals, they get poisoned by the high doses of alcohol used only periodically.

There is some new research coming out on the damage from binge drinking:
http://psychcentral.com/news/2014/12...lts/79265.html

And this article explains the brain damage binge drinking can cause:
https://www.quora.com/How-does-binge...fect-the-brain

I think you know you should stop all alcohol completely.
Much of your anxiety and discomforts will go away, if you stop.

If your Zoloft is the culprit, that will be easier to evaluate when alcohol is out of your life. You may need a dose reduction or a switch to a different antidepressant, if you have continuing depression.

Take care.

Thanks for the reply. I understand what you're saying about 'alcohol withdrawal'. Before this happened I was also of the opinion that it could only happen to chronic alcoholics. The first doctor I saw also didn't seem to believe that's what it was, but when I described it in detail to the second he agreed that that was what it sounded like. It's really the only thing that fits the symptoms - severe headache for a couple of days, followed by the worst of it 48-72 hours after stopping drinking. I had very high levels of anxiety, did not sleep for two days, had racing pulse and high BP, sweats, and shaking so bad my teeth were chattering. I believe I've suffered what is called 'kindling', in that my repeated binges followed by abstinence caused enough change / damage in my brain that having the alcohol influencing the GABA receptors for a weekend was enough to cause effects of withdrawal. I'm aware of the difference between a hangover and a proper withdrawal - but what I went through definitely fits withdrawal. That was most definitely not in my head!

Checked the supplements I have and the magnesium is indeed oxide. The B1 is Thiamin HCL. The B12 is cyanocobalamin. Sounds like those are all the wrong kinds?

I've been on the Zoloft now for almost 4 months. I had issues with it in the beginning but since I've stabilised on it I haven't had any side effects whatsoever. These kinds of parasthesias can be caused by it but I don't see how they could begin now after I've been on it for such a length of time.

I'm very aware that alcohol is the cause of all of this and I feel quite a bit of shame about having done this to myself. It sounds like you aren't convinced that my symptoms are typical of neuropathy?

Your symptoms really are similar to Antabuse reactions. Doctors have stopped using it for many years, now, so some of the newer ones would be unaware of the drug at all. Antabuse blocks the metabolism of the noxious aldehydes that build up in the body when alcohol is metabolized. We even know now today, that Antabuse (disulfiram) can even CAUSE neuropathies-- because aldehydes in high amounts are toxic to nerves.

On top of all that, some people inherit a low level of dehydrogenases that work in the alcohol/dehydrogenase system, and react with illness when drinking. You can look this up using a keyword search -- "genetic inability to metabolize alcohol".

As people use SSRIs over time, they can experience a decrease in dopamine in the brain. So using an antidepressant that works on dopamine instead of serotonin may help. There is only one...
Wellbutrin. You would have to discuss a change like this with your Zoloft prescriber, however.

We have a long thread for alcohol abstinence support here at this link:
http://neurotalk.psychcentral.com/thread104096.html

this thread is about the "paresthesias" that people discover when trying to abstain.
http://neurotalk.psychcentral.com/thread218428.html

Magnesium chelates, like glycinate, citrate or chloride (SlowMag) are better. They dissolve in the aqueous stomach contents and get absorbed in the intestine.
This is the mag thread here:
http://neurotalk.psychcentral.com/thread1138.html

The thiamine will work, but you need 300mg a day in divided doses, because it is quickly excreted. The benfotiamine lasts longer in the body so less is needed and less often. 150mg once a day is often enough. A severe deficiency would need 300mg a day for a while, with a reduction in 2-3 months, after that.

The B12 is best used with methylcobalamin, because many people cannot activate cyano form.. Another DNA mutation to the methylation system is quite common MTHFR and if you have this cyano is not activated in the body...and is mostly useless.
This should be taken only on an empty stomach 1mg or 5mg daily.

I've never taken Antabuse - the only thing I have been prescribed is the sertraline.

Thanks for the links, I had read through the alcohol thread but couldn't find anything that was similar to my situation. The parasthesia one is interesting though. It seems like the OP also had his begin some months after quitting.

The possibility of it being the sertraline is not one I had considered given that I have tolerated it very well since the initial adjustment period. The positive effect that has had on my social anxiety is the only half decent thing to have come out of all this so I am reluctant to quit the sertraline.

Is it possible that the sensations are actually caused by the anxiety? As you can tell from the length of my post I have thought about all this a LOT. It's scary not knowing exactly what is going on, especially after reading others' experiences of how debilitating neuropathy is

I am not suggesting you are taking Antabuse. This drug which was used to treat alcoholism, causes the same symptoms as a hangover... it increases aldehydes which is part of the metabolism of alcohol. The same thing happens in people with genetic problems with thiamine. Flooding the body with alcohol during binging produces the same types of symptoms.
It is mostly the aldehydes causing the symptoms. The alcohol itself is short lived in the body. The metabolic junk created, therefore is the real culprit.

Anxiety causes changes in breathing and hence, increases in parathesias in the periphery. Anxiety often leads to hyperventilation.

https://en.wikipedia.org/wiki/Paresthesia

Reading on the internet is not going to give you exact symptoms that you may have. Everyone is different genetically and if you have defects in specific areas of metabolism, your symptoms with heavy drinking will vary from others who may not have the same hand of cards.

Your headaches may be due to many other things too. That would be a task for your doctor to figure out.

But for now, quitting the alcohol is your first priority. Take it one step at a time.

Ah, I see what you mean. I've always tolerated alcohol well in the past though. That is the one and only time I experienced symptoms like that. When other people were throwing up or passing out I was always the one sorting the taxi. If I had a genetic predisposition towards alcohol intolerance would it not have shown up many years ago?

Thanks for your responses. I do appreciate you taking the time to help me out. It seems you are pretty indispensable around here

The burning/tingling in my left foot was worse today. It was going on all afternoon. I've booked an appointment with the doctor for 2 weeks' time. In the interim I will change the supplements and just hope it improves. If it continues to get worse...then I guess I'm screwed! Should I ask about a biopsy? It seems that is the most categorical way to determine the cause?

Feeling quite disheartened about my prospects right now...

Step one is to be examined by a Neuromuscular Neurologist. The skin biopsy would be further down the road if needed. The first visit would be a through physical exam, depending on what the doctor sees will determine the next step.

Hope this helps.....

Cliffman