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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 ZeeZee on February 16, 2003, at 10:22:21
Hi Jackie,
Just checking to see how you're doing with the tapering of the Paxil. I'm continuing to struggle and am discouraged. Keep us posted.
Regards,
ZeeZee
Posted by Jackster on February 17, 2003, at 0:07:48
In reply to Jackster - How are you doing?, posted by ZeeZee on February 16, 2003, at 10:22:21
Hi Zee Zee
Sorry to report that I'm feeling a little discouraged too! I've been back on the Paxil 40mg for 5 days - starting to feel less anxious - but I think it'll need to be at least a week before the full effects are back. I know it's my own stupid fault for blindly following my PDoc's directions to effectively halve the dosage in one week. I'm so sick of waiting to get better though. Am still on 10mg of Nortriptyline at night - but don't want to increase that until I'm back to stable on the Paxil. I think people with panic disorder really need to be very slow and gradual with adjustments to Paxil. (I have tapered from 40mg - 10mg in the past - it took several months but was relatively painless). I think I just need to be patient. (But 3 years of trying different meds makes that hard).
How come you are struggling with the Paxil? Are you still taking the Xanax? I know what it's like to be reluctant to rely on the benzos - that's another thing slowing me down. I could do this faster if I wanted to take the klonopin 24/7 - but as far as I'm concerned that just adds another problem on top of the rest.
The start up side effects of Paxil only last about 2 weeks - but I think you'll get them every time you up the dose. So maybe you could wait until you're comfortable with 10mg and then up it to 15 or 20mg.
Sorry if I'm babbling - let me know how you're doing.
Jackie
Posted by ZeeZee on February 17, 2003, at 15:54:37
In reply to Re: Jackster - How are you doing? » ZeeZee, posted by Jackster on February 17, 2003, at 0:07:48
I feel like you do - tired of waiting to get better. It's been 4 wks now (although only 2 wks at 10 mgs) and I was hoping I'd have a little taste of the benefits so as to renew my hope and motivation. Instead, I have fractured sleep (eyes pop open after 5 hrs), a dull knot in my gut, slight tightness and discomfort in my chest, constant loud ringing in my ears, anorgasmia AND I still have panic and agoraphobia. I had to take a xanax to stay put in the movies with my husband this weekend!!!!!!!!!!!! And on top of it all I believe I am now dependent on the xanax because I took .25 Friday night instead on .5 and all day Sat. my blood pressure and pulse was elevated (that's the eve I felt panicky at the movies)! It's kinda lie dieting and exercising for 4 wks and gaining weight!
I know I'm being a whiney, impatient, brat, but I'd like to know there's light at the end of the tunnel.
Sorry for the rant.
Zee
Posted by Jackster on February 17, 2003, at 23:41:56
In reply to Re: Jackster - How are you doing? » Jackster, posted by ZeeZee on February 17, 2003, at 15:54:37
I don't think you're a whiney impatient brat at all! I know what it's like to start new drugs, to go through all the side effects for a minimum of 4-6 weeks - only to come to the conclusion that it's not the one that's going to work for you.
I honestly don't know if 10mg is enough to have the benefits of Paxil. You're probably at the worst now - enough of a dose to get side effects, but not enough to actually get the benefit. (But I'm certainly no doctor so please don't take this as gospel).
You may have tried to reduce the Xanax dose a little too early. I understand that you're worried about being addicted (I feel exactly the same) but you may still be getting the start up effects of the Paxil since you're titrating it slower than what's normally recommended. (Which is what people with panic disorder usually have to do anyway because we're more susceptable to the side effects). So when they say that the start up effects only last the first couple of weeks - this is usually related to starting on 10mg the first week and then 20mg from then on. (Again - I'm not a Dr! This is my theory).
Have you thought about taking klonopin during the day - instead of Xanax at night? I've tried both - I find that Xanax is good for one off panic situations - and that klonopin (which is longer acting) - is good for background constant anxiety. This may make it easier on you during the day? I've also found that I get a good night's sleep when I've taken it during the day. It's also not as addictive as Xanax - but not as fast working. (I find it takes about 3/4 hour to get working).
I think the insomnia with Paxil is a frequent side effect - my PDoc prescribed 10mg of amitriptyline at night to deal with that. It's a very small dosage tricylic that's quite sedating. I never had any problems sleeping after that.
As for the anorgasmia - alas most meds that could help with that - tend to increase anxiety. There are such things as 'drug holidays' (skipping for a couple of days to get the feeling back) - but it's probably to soon for that. I found that side effect wore off a little if it's any consolation.
I hope this rant helps! I'm hanging in there with you - it's looking like my med change is going to take about another 6 weeks minimum. My boyfriend and I got engaged last year - people keep asking when the wedding is - and there's no way I'm ready for one now! I don't really feel like telling them the truth why either. Another pressure I don't need!
Jackie : )
Posted by ZeeZee on February 18, 2003, at 16:36:04
In reply to Re: Jackster - How are you doing?, posted by Jackster on February 17, 2003, at 23:41:56
First of all CONGRATULATIONS on your engagement!!!! How wonderful for you!!!! I totally understand your desire to wait and hope your fiance' agrees with you and supports your decision. I also can totally relate to not wanting to "explain". Take care of yourself first! worry about others later.
It sounds like you're feeling better. I'm sure it is frustrating though to have to wait another 6 weeks to make the change with your medicine. However, that's better than bringing extra misery you don't need right now.
Please let me express my appreciation again for your kindness and understanding. It really means a lot to receive your responses.
My pdoc is on vacation but relayed to me to switch my Paxil from eve to day to see if that'll improve my staying asleep. Last night I skipped my dose (slept worse than ever) and took it this morning.
So far what I feel is mostly what I call physical anxiety which I differentiate from panic or "fear". I have a fairly constant sense of "rushing" in my chest with tightness, almost like a sense of excitement. I can only assume that my internal workings are somewhat revved. It's tolerable although it's not particularly comfortable and I hope it will eventually go away. I don't like to take xanax for stuff like this, I'd prefer to save it for when I feel what I call the psychological anxiety, the fear, the need to flee.
Of course I'm still taking it at bedtime, although I don't really need anything to help me go to sleep right now - the problem is staying asleep.
I am curious about the amitrip. However, I'm the type to panic because of feeling sedated! My head has to be relaxed first. This is why I avoid alcohol, because it relaxes me physically but then I start thinking anxiously about it and then think "oh my God, now I can't take xanax, I might overdose" and on and on I go! I can only take something that will relax my thinking as well.I may take your advice and take Klonopin during the day. I never really got the "hang of it" and never felt like it did much, but then again, I didn't take it but a couple of times. Can you take xanax on top of it if you need? How much do you take during the day and does it make you sleepy?
Take care
ZeeZee
Posted by Jackster on February 19, 2003, at 3:30:32
In reply to Re: Jackster - How are you doing? » Jackster, posted by ZeeZee on February 18, 2003, at 16:36:04
Hi Zee Zee
I'm glad to be able to help you! And it's nice to talk to someone in a similar situation.
I forgot you were taking the Paxil at night - it's a good idea to try taking it in the morning if you're having problmes with insomnia. The physical anxiety you describe definitely sounds like the start up anxiety from Paxil. This should eventually wear off as your body gets used to it. (And from my experience isn't as bad the anxiety from panic attacks - just the physical sensation and not the negative thoughts that go with them). The klonopin would help - maybe even just having it in case would be comforting (if you're worried about addiction). I've taken 0.5mg for mild anxiety and 1mg when it's been quite bad. (per day) I usually end up feeling tired a few hours later - and sleep well that night. I have also taken Xanax on top of that (0.5mg?) when I had a panic attack shortly after I'd taken the klonopin. (which doesn't work straight away). I think these doses are quite low - prob at the start dose level.
I've only ever taken the amitrip at night just before I go to sleep - so all I experience from it is a 'sleepy' feeling before I'm out to it! Did initially feel a bit sedated during the day.
Thank you for the congratulations. I tend to focus on not being ready for the wedding day and not appreciating that it should be a happy time! Can I ask if you were agoraphobic when you got married? And if you were - how you coped on the day?
I've been feeling better since upping the Paxil dose to 40mg - so it was obviously titrating it too fast that caused the anxiety. I haven't needed to take klonopin for a couple of days now. So the next step is to up the nortriptyline to 20mg which I'm going to do after the weekend. I'm supposed to have an apptmt with my Pdoc next week - but I'm way behind on my dosage change so he'll just have to wait! (Am doing things at my pace now - not just blindly following instructions!)
I hope things are smoothing out for you now - you must be getting out of the worst soon and starting to get the benefits of the med!
take care!
Jackie
Posted by ZeeZee on February 19, 2003, at 9:20:09
In reply to Re: Jackster - How are you doing? » ZeeZee, posted by Jackster on February 19, 2003, at 3:30:32
Hi Jackie
It' always a pleasure to hear from you.
To answer your question about agoraphobia. No I wasn't experiencing this when I married (which was 24 years ago!), but it did rear its ugly head during my pregnancy with my son who is now 19. The panic and agoraphobia started after severe postpartum OCD and anxiety about 3 years later. Although, my anxiety dates back to early childhood.
Soooo, that's about 17 years worth of experience with it and right now I'm at my worst. It's more of an issue than the panic, if that makes any sense.Getting married is a BIG deal and a wedding is very stressful (is this your first?). Get yourself well first so you can fully enjoy it and have good memories of the day. There's no rush, again, I'm sure you've selected someone who is understanding of your problem and I'm sure will be patient with you. My husband is very understanding, has experienced this to a small degree himself at times, and is truly my best friend!
I made the switch Monday night, by skipping my dose and taking it Tuesday a.m. I don't know if you read my other post but as the day progressed the "chest rushes, or surges" were getting quite intense. Last night while sitting and watching TV and feeling both sleepy and relaxed I decided to take my blood pressure since I was still having these surges. It was 167/95! I really don't think my b/p has been like this all along, although I do think it's been somewhat higher than usual due to my anxiety over taking the Paxil.
This morning (I stayed home from work and slept in) before taking the Paxil, my b/p is perfectly normal! I wonder if it was the change of time of dose. Did you ever change your time of dose and experience any increase in symptoms?I'm still awakening and don't think this will change it. Since I go back to sleep I guess I can live with it for now. I will ask about the TCA when I speak to my pdoc. I'm afraid though she may yank me off the Paxil if I tell her about the b/p because I get the feeling she's concerned about litigation.
I'm so glad your switching of med's is going more smoothly and you're listening more to yourself. Again, I never fully trust my doctors no matter how wonderful they may be - they all make mistakes and don't live inside our skin!
Hope you continue to have an easier transition.Please keep me posted.
Regards,
ZZ
Posted by Jackster on February 22, 2003, at 23:21:09
In reply to Re: Jackster - How are you doing? » Jackster, posted by ZeeZee on February 19, 2003, at 9:20:09
Hi Zee Zee
Thank you for answering my nosy questions! One thing I am concerned about is when I do eventually want to get pregnant (in the next 4-5 years). I've talked to the doc about it - and he seems to think it would be better for me to be on a low dose SSRI than to go through the anxiety of being on nothing. Anyway - that's a bridge I'll cross when I come to it - but it seems to be coming up fast!
I hope you're getting more sleep now and your bp is OK. I think the start up anxiety from an SSRI could easily raise your blood pressure. I don't remember ever changing my dose time with Paxil I've always taken it in the morning. Some people find it to sedative so they take it at night. Have you talked to your doc about the TCA at all?
Take care
Jackie> Hi Jackie
>
> It' always a pleasure to hear from you.
>
> To answer your question about agoraphobia. No I wasn't experiencing this when I married (which was 24 years ago!), but it did rear its ugly head during my pregnancy with my son who is now 19. The panic and agoraphobia started after severe postpartum OCD and anxiety about 3 years later. Although, my anxiety dates back to early childhood.
> Soooo, that's about 17 years worth of experience with it and right now I'm at my worst. It's more of an issue than the panic, if that makes any sense.
>
> Getting married is a BIG deal and a wedding is very stressful (is this your first?). Get yourself well first so you can fully enjoy it and have good memories of the day. There's no rush, again, I'm sure you've selected someone who is understanding of your problem and I'm sure will be patient with you. My husband is very understanding, has experienced this to a small degree himself at times, and is truly my best friend!
>
> I made the switch Monday night, by skipping my dose and taking it Tuesday a.m. I don't know if you read my other post but as the day progressed the "chest rushes, or surges" were getting quite intense. Last night while sitting and watching TV and feeling both sleepy and relaxed I decided to take my blood pressure since I was still having these surges. It was 167/95! I really don't think my b/p has been like this all along, although I do think it's been somewhat higher than usual due to my anxiety over taking the Paxil.
> This morning (I stayed home from work and slept in) before taking the Paxil, my b/p is perfectly normal! I wonder if it was the change of time of dose. Did you ever change your time of dose and experience any increase in symptoms?
>
> I'm still awakening and don't think this will change it. Since I go back to sleep I guess I can live with it for now. I will ask about the TCA when I speak to my pdoc. I'm afraid though she may yank me off the Paxil if I tell her about the b/p because I get the feeling she's concerned about litigation.
>
> I'm so glad your switching of med's is going more smoothly and you're listening more to yourself. Again, I never fully trust my doctors no matter how wonderful they may be - they all make mistakes and don't live inside our skin!
> Hope you continue to have an easier transition.
>
> Please keep me posted.
>
> Regards,
> ZZ
>
>
Posted by ZeeZee on February 23, 2003, at 9:53:45
In reply to Re: Jackster - How are you doing? » ZeeZee, posted by Jackster on February 22, 2003, at 23:21:09
Hi Jackie
I definitely think it's a wonderful idea to be on a low dose SSRI if and when you get pregnant. I can only speak for myself, but although I was thrilled about being pregnant the hormone change as well as knowing I couldn't take a xananx or any type of tranquilizer was enough to greatly increase my anxiety and keep it there. It wasn't that bad with my first pregnancy, but was severe with my second and I suffered silently. Had I received help in a timely fashion I may not be where I am today. I also feel guilty as hell for the "hostile" pre-natal environment the constant surging of stress hormones caused for my son and feel responsible for his ADD and any other problems he has with his mood. I don't even know if they knew enough about this disorder back in the early 80's to have prescribed appropriate treatment, you are fortunate to have the benefit of progress on your side.
My problem with the b/p and surging of adrenaline only got worse. Combined with lack of a sleep I had some really bad days last week. My pdoc is on vacation but her receptionist is a hell of psuedo - doc and has been very helpful to me. I started taking a small dose of a beta blocker again along with my other b/p medicine and within a few days brought down my b/p to normal to below with a steady pulse in the 60's. It's a wonderful drug because it totally soothed me internally. I don't know if it's the beta blocker or that I've turned a corner with the side effects, but I do feel much better. I think switching to daytime dosing was a mistake because in spite of all the energizing it does to me it seems to also sedate me.
I'm postponing my day dose by 2 hours each day to get to a dinner time dose. I'm doing this on my own because my pdoc has a "rule" about not doing any type of phone consultations and requires I come in for a med check instead. Since I am agoraphobic and could no more drive to her than swim across the Atlantic and I must depend on my husband to take me. He cannot take off from work for two weeks. On Monday, she will return and will "relay" to her receptionist if I should just stay at 10 mgs or increase it as well as when I should take it.
I have had some spurts of panic within my "safe area" where I should not have or did not have any anxiety at all in the past. I did notice that the panic was "muffled" and short lived. In the past few days it seems to be further from the surface and harder to trigger so I think I may be experiencing the very early beginning of some benefits.
I wish you continued good luck and health. Stay on top of this disorder - it is chronic - and I learned the hard way (relapse after 8 years of being fairly symptom free) that it always requires treatment.
Regards,
ZZ
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