Posted by Karen on October 13, 1998, at 12:11:30
In reply to Re: More info, please, posted by Toby on October 13, 1998, at 10:19:32
> 1. Were you on medications when the breathing
difficulty first started? If so, had you been on
the medication for very long -- was it working for
the depression and then the breathing problem just
hit out of the blue, or did the problem start soon
after you got on medication? Does it continue
even when you are on no antidepressants at all? I
need to determine if it is a true side effect of
the medications or if it is maybe a new component
of the depression or even a whole separate anxiety
disorder. The jaw clenching and insomnia are
pretty clearly associated with the SSRI's.
> 2. You said the breathing problem continued
with the Effexor even though the depression got
much better. Did you also have the jaw clenching
and insomnia with the Effexor? And was it Effexor
XR or immediate release Effexor?
> 3. Let me assume a moment that the
overbreathing is a separate anxiety disorder.
SSRI's can be very helpful for panic disorder and
social phobia, but if you are having the jaw
clenching and insomnia, you are defeating the
purpose by using those medications. Since the
Effexor worked for the depression, perhaps your
chemical imbalance is more norepinephrine related
than serotonin related (although at only 37.5 mg,
Effexor tends to be identical to an SSRI and the
norepinephrine effects don't kick in until a much
higher dose, so that's a little confusing to me).
If your depression is related to norepi, then
maybe an older antidepressant like Pamelor would
be more helpful.
> 4. Celexa is more serotonin specific than any
of the others you have tried, so I might be a
little afraid they would cause the same problems
with sleep and jaw clenching.
> 5. When you say the overbreathing occurs all
day, do you mean it happens every moment you are
awake or does it come and go? Does it get worse
with stressful situations or in social situations
(talking to strangers or friends, giving a report
in a meeting, writing a check at the store,
talking on the phone, eating in public)? Do you
have other symptoms with the overbreathing like
heart palpitations, dizziness, chest pain,
numbness or tingling of the fingers or around your
lips, sweating, shaking, nausea, choking, hot
flashes, fear of losing control or falling? Can
you remember the specifics of the first time it
happened? Are you a worrier; do people say you
drive them nuts with indecision or smothering your
kids because you can't get the idea out of your
head that something bad might happen to them?
> 5. Buspar is a fine thing to try. It can
augment an antidepressant, hardly any interactions
with antidepressants, non-addictive, few side
effects. It does relatively little for pure panic
disorder, but if the breathing problem is isolated
and you have problems with muscle tension, worry,
irritability, restless sleep, and feeling on edge
all the time, Buspar would be worth a try. It
used to be thought that once a person was on a
benzodiazepine, that Buspar wouldn't work, but we
now know that is not necessarily so and I would
not deny a person the chance to try it based on a
history of taking benzo's.
> 6. Beta blockers have a reputation of making
depression worse and with Inderal that may be so
in some cases. However, Pindolol and Atenolol are
being shown to be quite effective for augmentation
of antidepressants and may help the anxiety also.
If you have a history of asthma, you can't take
these. If you aren't having heart palpitations
along with the breathing problem, I'm not sure
beta blockers would do much, but as long as you
are careful initially to start at a low dose and
work up slowly so your blood pressure stays level,
they couldn't hurt to try.
> 7. Another option is Nardil, an MAOI, which is
highly effective for anxious depression, panic,
etc. You have to follow a special diet (it really
isn't too hard) or there can be really bad
interactions, but some people respond to MAOI's
and nothing else.
> 8. Have you eliminated caffeine, chocolate,
smoking, OTC cold/sinus medications which might
give you these breathing problems or cause
anxiety? If not, do. Is your thyroid OK?
> 9. If I had you in my office, here's what I
would most likely do: a) If we determine that
the breathing is really a side effect of the
SSRI's and the Effexor, I would probably try you
on Pamelor up to 150 mg per day for the depression
and if that didn't do the trick, go to Nardil. b)
If we determine that the breathing is due to
anxiety and not the medication or a medical
problem, I'd try to figure out which anxiety
disorder it is. If panic disorder, I'd try
Imipramine, and if that didn't work, go to Nardil.
If it's generalized anxiety, I'd put you back on
the Effexor since that did work for the depression
and add Buspar for the anxiety (and most likely
switch to Klonopin because it's longer acting and
you won't have interdose withdrawal and hopefully
get you off the benzo in the future). If that
didn't do it, I'd add Pindolol. If all that
didn't work, then we'd get creative and look at
Lithium, Depakote, an atypical antipsychotic (not
because I'd consider you crazy but because
sometimes a small excess of dopamine can cause
strange symptoms of anxiety and a tiny dose of an
antipsychotic will fix it), or even a stimulant
(which sounds like it would make anxiety worse,
but sometimes it works). That's all I can think
of now. Happy to consider other info.
>>>> TOBY, More info.... I had my first panic
attack i was 8yrs and ended up in the ER they
dx'd anxiety and believe gave me benadryl. A
couple years ago my 7 yr almost died from an
Absess on his carotid(sp) atery. He was
transported by ambulance at 2 am to Syracuse
University Hospital for 2 weeks and then sent us
home with a nurse who came to our house 3 times a
day to give IV antibiotics. After that my
generalized anxiety became very bad ans not just
specificaly about the kids about EVERYTHING ie~
loosing a sneak, slipper huge startle response the
doorebell rings and I jump outa my skin. The
breathing has been very persistant on or off meds,
generally gets alittle worse wotj rapid heart
beat. sweating. this a.m I called the psych and
upped mu zanax to 4 times a day instead of 3. amd
told me when he sees me on friday he is going to
add something called neutontin(sp) to the mix.
YEs the neck thing contined on the effexor and
that's when he switched me to serzone. my dose on
serzone in now 300mg and Zanax 1mg 4 times a day
In a nutshell I feel the same as i did the first
time i walked into his office. Oh BTW- I took my
serzone without the zanaz and sure enough the
neck,jaw ans insomnia came back. We went out of
town for one day and had to take my sons paxil
(ADHD/anxiety disorder and dyscalculia) and his
ritalin and my serzone as well as the paxil
UGHHHHH well forgot my zanax. thats when the neck
thing kicked in. My other symptoms are being HUGE
worry. ie totally freak at 11pm if I cant find a
sneak, backpack, well you name it. 2 nights ago I
was frantic because I could'nt find my sons New
England Patriots glove. It isnt even snowing here
yet!!!! Not to mention worrying about the kids
homwork assignments, parties etc.
poster:Karen
thread:860
URL: http://www.dr-bob.org/babble/19981001/msgs/865.html