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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by jms600 on February 13, 2008, at 17:01:55
Hi everyone,
I've been taking 10mg of Lexapro for a fortnight now (switched from 30mg Remeron). The first week was hell - I'm sure the Lexapro was making my anxiety and panic attacks worse (as SSRIs can do), yet last week I actually started to feel better.
The anxiety started to subside and the panic attacks became less frequent and severe. I'm also taking 150mg of Seroquel, although I do question if that is actually doing anything - it certainly didn't help during my first week on the Lexapro.Tonight, however, seems to have gone back to my old dark days. The anxiety has returned with a vengence. I've had crippling panic attacks and the future, all of a sudden, seems so bleak. I've been feeling a little anxious over the last few days - but tonight has really been bad.
I've taken 10mg of Valium - and even that hasn't killed my anxiety like it usually does. I'm really starting to worry - has the Lexapro 'pooped out'?? Have I really got to put up with this suffering for the rest of my life..?
Can anyone advise - is tonight just a temporary relapse? Is it common with Lexapro to get such severe relapses? I know I've only been on the 10mg of Lexapro for a fortnight now, but what worries me is that I felt relatively good last week, yet tonight has been so bad - with the anxiety and panic similar to what I would have been like before I started the Lexapro.
Any advice would be much appreciated!
Thanks!
Posted by Phillipa on February 13, 2008, at 17:34:42
In reply to Lexapro for 2 weeks... now somethings gone wrong., posted by jms600 on February 13, 2008, at 17:01:55
Well I wonder if lexapro is the med for you what do you think? Have you called your doc? The seroquel I would think would help with anxiety. But you say no? And no help from l0mg of valium? May I ask what your diagnosis is and what other meds you've been on in the past? Or currently with lex and seroquel? Love Phillipa
Posted by garyengelm on February 13, 2008, at 20:08:12
In reply to Lexapro for 2 weeks... now somethings gone wrong., posted by jms600 on February 13, 2008, at 17:01:55
I wouldn't give up. Two weeks is nothing to be on Lexapro. I got the same initial good feeling like you did and started 5 weeks ago. I titrated slower to avoid side effects, but I'm at 12.5mg now and my pdoc wants me to be at least to 20mg if not 30mg.
When your Serotonin levels raise, it can be very activating, hence the increased anxiety and can be worse even more so than the initial anxiety you had prior to starting. Is your Depression better? Most people with anxiety feel a little lift in the Depression before the anxiety gets better.
Hang in there and use the benzos more frequently until you get to your goal dose. More can be better if your Serotonin levels are low to start with as in my case. Feel free to email me with any questions. I'm an RN x 14 yrs. I understand this stuff down to the cellular level. Don't despair, again 2 weeks is nothing to be on any SSRI. What you initially felt was purely a chemical reaction. I've been there...It's like some one flicked on a switch and you feel perfect only for everything to return after a few days. It's just chemical and not the true drug effect you will get with continued use.
I'm not guaranteeing that Lexapro is the drug for you, but you have to give it more time. Again, use the Benzos while your body is adjusting. Another sign is if your sleep patterns change. If you notice your getting up earlier or having trouble falling asleep, these are all signs the activation of the drug is working, which is what you want.
Gary ***** BSN, RN
Posted by rskontos on February 13, 2008, at 21:35:48
In reply to Re: Lexapro for 2 weeks... now somethings gone wro, posted by garyengelm on February 13, 2008, at 20:08:12
I was only going to add that to Gary's advice, although no rn, when I was on lex it took the full 4 weeks to really feel like my anxiety levels were contained. But I was prepared by my neuro that my anxiety might even get revived up due to the change in brain's chemistry, my words not hers. So I expected it. And knowing it sure made it easier. I think sometimes our expectations are for a quicker response and then we think oh this isn't working whereas my neuro's preparation and understanding she gave me I did not expect too much and gave it a chance and did not too frustrated.
I hope that makes sense. I guess I had more patience with more information. rsk
Posted by Glydin on February 14, 2008, at 10:34:26
In reply to Lexapro for 2 weeks... now somethings gone wrong., posted by jms600 on February 13, 2008, at 17:01:55
My startup on Lexapro was difficult to get thru. For me, it was a process rather than any spontaneous regression of my symptoms and yes, some days felt like two steps forward and one step back.
Toxic anxiety is a wretched thing to have as a challenge. My anxiety comes with a heavy dose of hypervigilance and catastrophic thinking thus my startup was punctuated by constant emotional and physical temp taking. This close attention did lead to a number of: Uh Oh, its back and I feel worse than ever times. I do think benzos are helpful for smoothing the edges. For me, all I endured was part of the righting of the chemical stew. It took 6-8 weeks for the good times to outweigh the nasty times. Yes, it felt like a lifetime at the time. The startup trait of going between ruts to clear road was temporary.
The message I would like to convey is one cant know what's on the the other side of a process until one goes thru to see it. That journey may be painful at times.
My history is: unipolar depression and anxiety - garden variety inclusive of just about all anxiety symptoms recognized. I have been in recovery almost three years. Lex is the only med I take. I have not needed a benzo for about a year and a half now.
Good Luck to you
Posted by jms600 on February 14, 2008, at 16:11:38
In reply to Lexapro for 2 weeks... now somethings gone wrong., posted by jms600 on February 13, 2008, at 17:01:55
Hi everyone
Thanks for the postings.
My current diagnosis is moderate depression; general anxiety disorder; social phobia; fairly severe panic disorder; as well as morbid obsessive thoughts and rumination.
I've tried all the SSRIs over the past 5 years apart from Citalopram (don't think there's much point trying it as I'm already on Escitalopram). Also taking Seroquel. I have, in the past, also been on Remeron; Effexor; Buspirone; Stelazine; and finally, Valium.
Thanks for your support!
Posted by elanorroosevelt on February 16, 2008, at 9:51:41
In reply to Re: Lexapro for 2 weeks... now somethings gone wro, posted by jms600 on February 14, 2008, at 16:11:38
if the lexapro is waking youup early, get up and do something
lexapro can be agitating at first but you learn togo with it
you should be taking a larger dosagebut if your sense of future does not come back in the next few days i would call it a meltdown
the lexapro meltdown can do that-crash your sense of future and let in the fear
Posted by Dopamine123 on February 21, 2008, at 17:20:24
In reply to Re: Lexapro for 2 weeks... now somethings gone wro, posted by elanorroosevelt on February 16, 2008, at 9:51:41
Anxiety from SSRI's is usually caused by increased activation of specific serotonin receptors. SSRI's increase serotonin in the synapse which activates multiple receptors.
Agonist activation of the 5-HT1A receptor mediates the antidepressant/anti-anxiety effects of the SSRI's, while activation of 5-HT2A, 5-HT2C, 5-HT3 and several others, mediate the side effects (such as increased anxiety, insomnia).
Seroquel blocks the 5-HT2A receptor and decreases serotonins effect there, which is good for anxiety/sleep. However It isn't an antagonist at other serotonin receptors.
Risperidone is an antagonist at serotonin 5-HT2A receptors and 5-HT2C receptors.
Remeron antagonizes the 5-HT2A, 5-HT2C, and 5-HT3 receptors.
Ziprasidone is an antagonist at serotonin 5-HT2A, 5-HT2C receptors while being an agonist at 5-HT1A receptors.
So you might want to try a different drug that gives you antagonistic action (decreasing serotonin effects) at 5-HT2A, 5-HT2C and 5-HT3 receptors while being agonist (increasing serotonins effect) at 5-HT1a receptors. That should give the best antidepressant/anti-anxiety effect.
Hopes that's not too technical.
My neuroscience/neurotechnology blog:
http://brainstimulant.blogspot.com
Posted by jms600 on February 23, 2008, at 10:27:51
In reply to Re: Lexapro for 2 weeks... now somethings gone wro, posted by Dopamine123 on February 21, 2008, at 17:20:24
> Anxiety from SSRI's is usually caused by increased activation of specific serotonin receptors. SSRI's increase serotonin in the synapse which activates multiple receptors.
>
> Agonist activation of the 5-HT1A receptor mediates the antidepressant/anti-anxiety effects of the SSRI's, while activation of 5-HT2A, 5-HT2C, 5-HT3 and several others, mediate the side effects (such as increased anxiety, insomnia).
>
> Seroquel blocks the 5-HT2A receptor and decreases serotonins effect there, which is good for anxiety/sleep. However It isn't an antagonist at other serotonin receptors.
>
> Risperidone is an antagonist at serotonin 5-HT2A receptors and 5-HT2C receptors.
>
> Remeron antagonizes the 5-HT2A, 5-HT2C, and 5-HT3 receptors.
>
> Ziprasidone is an antagonist at serotonin 5-HT2A, 5-HT2C receptors while being an agonist at 5-HT1A receptors.
>
> So you might want to try a different drug that gives you antagonistic action (decreasing serotonin effects) at 5-HT2A, 5-HT2C and 5-HT3 receptors while being agonist (increasing serotonins effect) at 5-HT1a receptors. That should give the best antidepressant/anti-anxiety effect.
>
> Hopes that's not too technical.
>
> My neuroscience/neurotechnology blog:
> http://brainstimulant.blogspot.com
From what you have written above, are you saying that Remeron would be the best AD for me to try?I have tried Remeron some time back, and I have to say it was the worst AD I have ever taken! It did nothing but exacerbate my anxiety. In fact, out of all the ADs I have tried Remeron has to be the worst!
Posted by Dopamine123 on February 25, 2008, at 10:51:54
In reply to Re: Lexapro for 2 weeks... now somethings gone wro, posted by jms600 on February 23, 2008, at 10:27:51
"From what you have written above, are you saying that Remeron would be the best AD for > me to try?"
Nope, its just one possiblity I gave. If it didn't work for you, then don't try it again.
"I have tried Remeron some time back, and I have to say it was the worst AD I have ever taken! It did nothing but exacerbate my anxiety. In fact, out of all the ADs I have tried Remeron has to be the worst!"
Well remeron increases norepinephrine at higher doses due to its effect on alpha-2 adrenergic receptor, so it was probably increasing anxiety through that mechanism. So the dose you were on was probably too high.
http://www.preskorn.com/columns/0003.html
"However, higher doses of mirtazapine result in the blockade of the alpha-2 adrenergic receptor, which produces an alerting or arousal effect just like yohimbine and just the opposite of the sedation produced by the alpha-2 adrenergic agonist, clonidine."Every person's brain is different, that's why I gave 3 different things you could try. Your on an antipsychotic anyway, so you might want to try a different antipsychotic.
http://www.preskorn.com/columns/0003.html
"Agonism of the 5-HT1A receptor is currently believed to be the mechanism mediating the antidepressant efficacy of these drugs. Conversely, agonism of the 5-HT2A, 5HT2C, and 5-HT3 receptors may principally mediate the adverse effects of these drugs: sleep disturbance, anxiety and weight gain, and nausea/loose stools/vomiting, respectively."
This is the end of the thread.
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