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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by AnneL on October 18, 2002, at 21:36:34
I need some help. I have been depressed for a good 2 weeks now. I just want to sleep and am withdrawing from friends and family. I have been on Effexor XR 225 for over 1 1/2 years and Klonopin 1 mg. at night. I can't tolerate more than 225 of Effexor or else I get jittery. I will see my pdoc, but does anyone have any ideas?
I need a kickstart or something. . . Thanks.
Posted by Ritch on October 19, 2002, at 10:20:03
In reply to Effexor poop out - What next? Depression back, posted by AnneL on October 18, 2002, at 21:36:34
> I need some help. I have been depressed for a good 2 weeks now. I just want to sleep and am withdrawing from friends and family. I have been on Effexor XR 225 for over 1 1/2 years and Klonopin 1 mg. at night. I can't tolerate more than 225 of Effexor or else I get jittery. I will see my pdoc, but does anyone have any ideas?
> I need a kickstart or something. . . Thanks.Anne, it sounds like you could benefit from an add-on of a sedative AD at bedtime so you can get to sleeping properly. You might try some Remeron. However, you might find a little amitriptyline or nortripytline more tolerable and much less appetite stimulating than Remeron.
Posted by AnneL on October 19, 2002, at 13:39:19
In reply to Re: Effexor poop out - What next? Depression back, posted by Ritch on October 19, 2002, at 10:20:03
Thank you for responding Ritch. I agree with the need to get proper sleep. I know that Klon and Effexor are interfering with normal REM and that Klon is giving me morning hangover. I also know that Effexor is aiding and abetting my feelings of apathy. I have been on this combo for almost 2 years now and I have had enough. I love my life, I have a lot to be greatful for and I can smell the roses so to speak. I dislike not being able to get up without a struggle and really dislike not feeling like I have the energy to get up and exercise. This med combo may have been necessary 2 years ago, but it is now interfering with my quality of life. I am going to taper down off Effexor by 37.5 mg. per week and probably use Prozac during the final week to avoid the horrible withdrawl reactions (I have had a taste of this by missing a dose). The same goes for Klonopin, 1/4 tab taper per week and will hold steady at 1/4 tab until I am well off the Effexor and then deal with the final Klon taper very, very carefully. I feel really good today with my resolve to be proactive in taking care of myself. Exercise makes me feel great and in control, not feeling like exercising makes me feel lazy and not in control. I want the good parts of my life back. Finally, for me Effexor has been a great med and I have no regrets.
If I need it again, I would have absolutely no qualms in resuming Effexor.
Posted by AnneL on October 20, 2002, at 13:27:01
In reply to Effexor poop out - What next? Depression back, posted by AnneL on October 18, 2002, at 21:36:34
Hi Ritch,
OK I have bounced from I am depressed to I am getting off of meds to I am depressed or I am having a side effect of Effexor/Klonopin combo
(long half life of Klonopin causing fatigue, Effexor causing SSRI/SNRI apathy if this is a credible side effect). I am not trying to put you on the spot, but just am very curious as to why you suggest a sedating augmentation strategy with Remeron, Elavil or Pamelor. Aren't I getting enough sedation with the Klonopin? It certainly makes for one to dread having to get up for work in the morning! Any ideas you or other fellow babblers may have to help me get going? Thank you so much! Anne :)
Posted by Ritch on October 20, 2002, at 16:12:56
In reply to What is rationale behind adding sedative AD? » AnneL, posted by AnneL on October 20, 2002, at 13:27:01
> Hi Ritch,
> OK I have bounced from I am depressed to I am getting off of meds to I am depressed or I am having a side effect of Effexor/Klonopin combo
> (long half life of Klonopin causing fatigue, Effexor causing SSRI/SNRI apathy if this is a credible side effect). I am not trying to put you on the spot, but just am very curious as to why you suggest a sedating augmentation strategy with Remeron, Elavil or Pamelor. Aren't I getting enough sedation with the Klonopin? It certainly makes for one to dread having to get up for work in the morning! Any ideas you or other fellow babblers may have to help me get going? Thank you so much! Anne :)Hi, you've got some interesting questions. The main thing I got from your original post was that you were experiencing some bad insomnia and that you were still depressed (hence the sedative AD idea). Klonopin (as do other BZD's) can make sleep somewhat less restful overall despite them being effective at getting you to sleep. Benzos can also aggravate depression in many people. I found that I tend to get worsened depression (I feel "sullen")if I take more than .5mg of Klonopin a day. Diazepam was *very* depressogenic for me in the past. What about... asking your pdoc about switching the Klonopin to a BZD that is shorter-acting and has a better effect on mood such as Ativan or Xanax to take only at bedtime? You should feel less tired the next day and you might sleep better on those two. Ativan really knocks me out. SRI-induced apathy is very real. They can also aggravate insomnia too.
Posted by AnneL on October 21, 2002, at 0:31:35
In reply to Re: What is rationale behind adding sedative AD? » AnneL, posted by Ritch on October 20, 2002, at 16:12:56
Yes, I think you have a point about Klonopin either causing depression or potentiating one's depression. It certainly does give me a "hangover" in the morning. Unfortunately, I get rebound anxiety from short-acting benzos such as Xanax and the rebound anxiety is intense. I don't rebound with Klonopin due to it's 18 hour (?) or so half-life. My pdoc has suggested that I taper down on Klonopin to see if I "pick up". How do people deal with the SSRI/SNRI apathy issue? Are there any augmentation strategies to help deal with this? I appreciate your input. Thanks, :) Anne
Posted by Ritch on October 21, 2002, at 9:54:43
In reply to Klonopin hangover/Effexor Apathy - Ideas? » Ritch, posted by AnneL on October 21, 2002, at 0:31:35
> Yes, I think you have a point about Klonopin either causing depression or potentiating one's depression. It certainly does give me a "hangover" in the morning. Unfortunately, I get rebound anxiety from short-acting benzos such as Xanax and the rebound anxiety is intense. I don't rebound with Klonopin due to it's 18 hour (?) or so half-life. My pdoc has suggested that I taper down on Klonopin to see if I "pick up". How do people deal with the SSRI/SNRI apathy issue? Are there any augmentation strategies to help deal with this? I appreciate your input. Thanks, :) Anne
I read your post below about Klonopin relieving 'Effexor-induced' nighttime panic attacks. That sounds a little scary. What is your doctor's thinking about that? Have you tried other antidepressants that cause the same thing? What does your doctor think about switching to an AD that doesn't 'trigger' the nocturnal panic? Sorry for the questions, but it is an intriguing subject (antidepressant induced panic). Do you think you would benefit from a dose *reduction* of Effexor (in the apathy and nocturnal panic department)?
Posted by AnneL on October 21, 2002, at 22:31:53
In reply to Re: Klonopin hangover/Effexor Apathy - Ideas? » AnneL, posted by Ritch on October 21, 2002, at 9:54:43
My first nocturnal panic attack was more than 20 years ago at the age of 18. My undiagnosed panic disorder went away after a year (no SSRI's back then, no Xanax either). I simply got fed up of being hostage to the fear and must have used some form of self-cognitive therapy. About 4 years ago, I tried Celexa and 4 nights later I ended up with a doozy of a panic attack (911, paramedics, the whole nine yards). Tried Paxil, same thing. Then 1 1/2 years ago or so went on Effexor, but kept having nocturnal panic attacks, really adrenaline rushes and Xanax kept rebounding on me so that's when I thought I could use a benzo with a longer half-life. Klonopin stopped them from occuring almost entirely. I only had a panic attack when I went longer than 24 hours without Klonopin and this was probably a withdrawal reaction. Really, in the scope of things my side effects are very small compared to others. I may need to taper down on Effexor and see if I can get off the Klonopin. I am pretty sure in my case that I have a morning hangover from Klonopin.
:) Anne
Posted by Ritch on October 22, 2002, at 0:06:24
In reply to Re: Klonopin hangover/Effexor Apathy - Ideas?, posted by AnneL on October 21, 2002, at 22:31:53
> My first nocturnal panic attack was more than 20 years ago at the age of 18. My undiagnosed panic disorder went away after a year (no SSRI's back then, no Xanax either). I simply got fed up of being hostage to the fear and must have used some form of self-cognitive therapy. About 4 years ago, I tried Celexa and 4 nights later I ended up with a doozy of a panic attack (911, paramedics, the whole nine yards). Tried Paxil, same thing. Then 1 1/2 years ago or so went on Effexor, but kept having nocturnal panic attacks, really adrenaline rushes and Xanax kept rebounding on me so that's when I thought I could use a benzo with a longer half-life. Klonopin stopped them from occuring almost entirely. I only had a panic attack when I went longer than 24 hours without Klonopin and this was probably a withdrawal reaction. Really, in the scope of things my side effects are very small compared to others. I may need to taper down on Effexor and see if I can get off the Klonopin. I am pretty sure in my case that I have a morning hangover from Klonopin.
> :) Anne
Anne, it seems that you are REALLY sensitive to SRI meds such as Effexor, Paxil, Celexa. Has your pdoc ever discussed with you trying non-SRI AD's such as Remeron, TCA's, MAOI's to try to control your panic/depression? Also, have you ever had a neurological workup such as a 24-hr EEG to see if you might be having seizure activity in your sleep? My Mom had nocturnal generalized seizures, and we both have had panic attacks in the past.
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