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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Vincent_QC on January 10, 2010, at 12:13:01
Hi Everyone!
Here the story... Was on the Paxil last summer for panic disorder and GAD. Start it at 10mg with no increase anxiety side-effect...and was able to reach the 30mg in less than 2 months.I had to stop it because it was making me very sedated and I gained a lot of weight on it.
2 weeks after I stop it, I had a surgery, a very painfull one... and the panic attacks start again but at a worse level.
Since the end of november, I have to deal with constant head pain (tension headache or cluster headache), 5-10 panic attacks a day (trigger or not), can't leave the house alone and avoid social situation. I have no energy and feel all the time anxious because I can't stop thinking about everything (my future, job, money, anxiety)... I have burning eyes sensation, pressure behind the eyes as well and a lot of others strange pain in the chest, the JAW, the legs and the arms... My blood pressure is higher than usual and my pulse rate is very slow when I do nothing... and as soon as I move, walk or do a task who ask for some energy, my heart start racing very fast and I start a panic attack...
My PDoc put me again on the Paxil in the begining of december. I start it at 5 mg day. I was not able to tolerate it at all. I had the opposite effect than the one I had last summer. Increase anxiety, fast pulse rate, sweating, unable to drive my car, panic attacks occur everywhere... The second day I cut the 5 mg into a small 2,5 mg...and I stay at 2.5 mg for 1 1/2 weeks and stop it becauee the increase anxiety never decrease...
I see my Family Doc in the middle of December and he suggest to start the Neurontin for the head pain. The neurontin didn't work, just had pins and needles effect...like I had before on the Topamax as well...not very effective for anxiety and panic... or even for pain related to the head...
I see the Family Doc again last week and he give to me some sample boxes of Cipralex (Lexapro in tue USA). I start it at 2,5 mg, had to cut the pill in 4 pieces. I had an extreme bad reaction to it, worse than the one I had on the Paxil the month before. Worse ever anxiety with a lot of panic attacks, dizness, tinnitus, increase head pain, tremor, extreme sweating...and the list goes on...really don't want to stay on it or wait at home alone until the increase anxiety start to fade away... if it fade away...
I stop it after just one small 2,5 mg dose. Strangely, I was on it more than 1 year ago at 20mg and never had any problem or side-effects except the extreme sedation and weight gain...
So I wonder what happen to me???
Did I produce too much cortisol, adrenaline???
Is is possible that the panic disorder and GAD is back because I had a post-traumatic stress induced by the painfull surgery?
Do I will have to start again the Paxil at 1mg a day and increase the dosage on 20 weeks to reach the 20mg /day??? That's seem not very realistic for me !!!
What's wrong with my brains?
Do I will have less increase anxiety on the Zoloft at first... or on the Effexor-XR ?
Since i'm a lot focus into my heart, the TCA's are out of question and the MAOI's also...The Remeron is also not an option for me... I don't find sedative meds to be helping for the anxiety or panic disorder...and no anti-psychotic meds like the Zyprexa, Risperdal or Seroquel... they don't help a lot...
Any others off-label meds that I miss? Lyrica, Lamictal???
I'm taking now 8 mg day of Rivotril, who seem to do nothing, just adding more fatigue and cognitive problems on me...
Any help will be appreciate!!!
Thanks!
Vincent
Posted by Phillipa on January 10, 2010, at 12:40:31
In reply to SSRI with the less initial increase anxiety..., posted by Vincent_QC on January 10, 2010, at 12:13:01
Vincent as said before luvox had absolutely no side effects first time took it with xanax. Hope the headaches gone today. Love Phillipa
Posted by janejane on January 10, 2010, at 13:05:54
In reply to Re: SSRI with the less initial increase anxiety... » Vincent_QC, posted by Phillipa on January 10, 2010, at 12:40:31
I don't know the answers to your questions, but hopefully others will be able to help. Just wanted to let you know I'm sorry you're having such a hard time.
Posted by Justherself54 on January 10, 2010, at 14:51:53
In reply to Re: SSRI with the less initial increase anxiety... » Phillipa, posted by janejane on January 10, 2010, at 13:05:54
Sorry to hear you're having such a rough time Vincent. I don't know what's causing such extreme reactions to meds you've used before. What happens to me when I retry a med is it either doesn't work or I just get a partial response.
Have you ever tried Zoloft. It would be my preferred med if it would work again.
What about using a benzo to help with the initial start up anxiety of a med?
Hopefully, others will chime in and help. Best wishes to you.
Posted by janejane on January 10, 2010, at 15:52:40
In reply to Re: SSRI with the less initial increase anxiety..., posted by Justherself54 on January 10, 2010, at 14:51:53
> Have you ever tried Zoloft. It would be my preferred med if it would work again.
Just wanted to comment on the above, because I tried zoloft for three days and had to quit because it made me unbearably anxious at even a small dose. I think it has the reputation for causing anxiety in some people, especially at start-up.
Posted by Vincent_QC on January 10, 2010, at 22:18:03
In reply to Re: SSRI with the less initial increase anxiety... » Phillipa, posted by janejane on January 10, 2010, at 13:05:54
> I don't know the answers to your questions, but hopefully others will be able to help. Just wanted to let you know I'm sorry you're having such a hard time.
Thanks for your support janejane ;-) I really appreciate it!!!Bye!
Vincent ;-)
Posted by Vincent_QC on January 10, 2010, at 22:43:37
In reply to Re: SSRI with the less initial increase anxiety..., posted by Justherself54 on January 10, 2010, at 14:51:53
> Sorry to hear you're having such a rough time Vincent. I don't know what's causing such extreme reactions to meds you've used before. What happens to me when I retry a med is it either doesn't work or I just get a partial response.
>Same here... but now it's seem that I can't tolerate any SSRI or any older antidepressant meds... Maybe I have too much serotonin also??? But everything who it too much the serotonin, the noradrenaline or the dopamine make me very anxious and trigger panic on me...
The only med that I can tolerate is the Remeron, but it's not helping me at all... I just gain weight on it...
> Have you ever tried Zoloft. It would be my preferred med if it would work again.
>I try it 2 times in my life... First time I go up to 200 mg for social phobia for more than 6 months... didin't work at all... and I didn't had any side-effects exception of the MAJOR weight gain... more than 60 pounds... and contrary to what the pharmaceutical compagny who produce it clain about the Zoloft, I gain a lot of weight while I was taking it...
The second time I try it was in the spring of 2008, I notice no increase anxiety at first... but I didn't had panic disorder and GAD problem at the time... just social phobia... and strangely, when I hit the 150mg and more, I start having panic attacks again once in a while and I was already on the Valium 20mg day at the time and I had to ask for something more strong than the Valium to help to cope with the high anxiety from the Zoloft... I ending on a very high dose of Xanax... go up to 12 mg a day of it...
After the Zoloft, I stay on the 12 mg of Xanax, who was not helping me a lot with the panic and the social phobia...so I was put on the Effexor-XR...who allow me to go on a strict diet (had anorexia problem because of it), increase the Effexor-XR to more than 450 mg day... and didn't see any improve for the social phobia or the anxiety ... it was too much activating for my taste... I end up at the Psychiatric emergency for high addiction from the Xanax and had to stop the Effexor-XR because I was loosing too much weight and I was overtired of everything...
I withdrawl the Xanax alone at home, cutting 0.25mg each week... had terrible cognotives problems (not able to speak, loose of memory, tremor, rebound anxiety) for more than 2 months of time...
I was put after on the Lexapro, who was one of the stronger sedative SSRI for me... go up to 20mg in less than 1 month... notice nothing good for the anxiety or the social phobia on it... stay on it for almost 3 months... and gain a beautifull 55 pounds in 3 months because I was always in my bed or in the fridge, eating a lot of foods...
I try to add the Wellbutrin with the Lexapro, who didn't help for the energy... I also try the Lexapro with the Ritalin for the energy with no success... so I just stop the Lexapro and all the others meds and keep my low dose of Valium at 20mg...
I meet my new PDoc in december 2008 and he put me on the Parnate, who turn out to be the most dangerous move I do in my life... I got severals hypertensives crisis not linked to any diet restriction or food to avoid!!! Had to go to the emergency often because of this...and carying with me some Nefipidine and use it often to slow down my blood pressure...
Because of the Parnate, I got a new phobia... and i'm now always focus in my heart... IF my blood pressure is too high, I start a panic attack... if my pulse rate is high, I start a panic... if my pulse rate is low, I start a panic... if I go to the gym and my pulse rate raise above 120, I start a panic... When I do tasks who normally trigger panic, like driving my car or going to the shopping center, my heart start racing and I start a panic... even in the shower I have panic attack...
Now, the social phobia is not my main problem and panic disorder is making my life miserable, as well as the GAD...
I have some nasty symptoms who last forever, like the head pain or cluster headache... who trigger also panic, I sweat a lot and many others things like that... I can't read too much or focus on something for a long time... I forget a lot of things (short term memory) and I feel just like I will never recover from this state...mentally speaking I mean...my cognitives abilities are very low now...
> What about using a benzo to help with the initial start up anxiety of a med?
>I already take 8 mg a day of Rivotril (Clonazepam), who is the maximum dosage I can use... I don't want to return on the Xanax because I know the withdrawl will be very hard... The Rivotril don't help, but i'm addicted and can't lower my dosage... the only way to lower it and return on a low dose of Valium will be to find a med who will stop the panic disorder and decrease my anxiety... If I find one, I will be able to start to withdrawl the Rivotril...since I hate being addicted to a med like the Benzo...
> Hopefully, others will chime in and help. Best wishes to you.
I hope!!!
Thanks for your advises!!!
Vincent ;-)
Posted by Meltingpot on January 11, 2010, at 4:31:15
In reply to SSRI with the less initial increase anxiety..., posted by Vincent_QC on January 10, 2010, at 12:13:01
Hi Vincent,
You sound like you are going through absolute hell. You said that you have tried Zyprexa and it didn't help. What dose did you take? I find that 10mg now and again really helps calm me down for the following days.
Also, just to give you my experience. When I was in my 20s I had a great response to 20mg of Paxil, no anxiety or anything.
Then when in my 30s and my depression came back, every SSRI seemed to increase the anxiety at the start up dose. After two years the Doctor put me straight on 40mg of Paxil and voila the anxiety and depression lifted. My point here is that the lower doses actually had more side effects for me than the high dose. Maybe when you are taking a low dosse SSRI it is just not working at all and the anxiety you are experiencing is your own anxiety which sounds pretty bad.
Also, from some of your other posts I know you are very worried about affects on your heart. I don't really understand why because when I'm feeling that bad I sort of hope I will have a heart attack and just fall down dead, that might sound silly but that's how I feel.
Why are you so concerned about your heart, do you have a history of heart problems? Do you think you are working yourself up into a state by worrying unnecessarily about having a heart attack? I know that when I'm feeling anxious it's absolutely awful and feels horrible but I never actually worry that I'm going to die from it. It is such a shame because an MAOI like Nardil might help you. It didn't really help my depression but it did seem to help the anxiety a bit. Also, I know you said you don't want to go on tricyclics but something like Clomipramine might eventually help you, I did get a lot of anxiety on it initially but after about five weeks that subsided.
I really hope you can find something for this anxiety. Please keep us updated.
Denise
Posted by Vincent_QC on January 11, 2010, at 8:31:47
In reply to Re: SSRI with the less initial increase anxiety..., posted by Meltingpot on January 11, 2010, at 4:31:15
> Hi Vincent,
>
> You sound like you are going through absolute hell. You said that you have tried Zyprexa and it didn't help. What dose did you take? I find that 10mg now and again really helps calm me down for the following days.
>I was put on it for almost 3 months, years ago at 5mg...and increase to 20mg...if I can recal well... not very helping... I find that meds who are suppose to be good for the anxiety by working on the H1 receptor and create a sedated state, are not really helpful in reallity... I took also a lot of Seroquel to help me to sleep... go up to 100mg every night and at the end it was not helping me at all to sleep...and for the anxiety forget it... The morning after you feel very dizzy and tired... and tolerance build up very fast for the H1 effect...
> Also, just to give you my experience. When I was in my 20s I had a great response to 20mg of Paxil, no anxiety or anything.
>
> Then when in my 30s and my depression came back, every SSRI seemed to increase the anxiety at the start up dose. After two years the Doctor put me straight on 40mg of Paxil and voila the anxiety and depression lifted. My point here is that the lower doses actually had more side effects for me than the high dose. Maybe when you are taking a low dosse SSRI it is just not working at all and the anxiety you are experiencing is your own anxiety which sounds pretty bad.
>Well, I always have to start at low dose, i'm sensitive to meds in general. The side-effects I experiences on the Paxil 1 month ago and on the Lexapro last week was REAL!!! I know the difference between anticipatory anxiety, who happen generaly 20-30 minutes after you take a med, and REAL side-effects who last more than 1 day!!!
> Also, from some of your other posts I know you are very worried about affects on your heart. I don't really understand why because when I'm feeling that bad I sort of hope I will have a heart attack and just fall down dead, that might sound silly but that's how I feel.
>
> Why are you so concerned about your heart, do you have a history of heart problems? Do you think you are working yourself up into a state by worrying unnecessarily about having a heart attack? I know that when I'm feeling anxious it's absolutely awful and feels horrible but I never actually worry that I'm going to die from it. It is such a shame because an MAOI like Nardil might help you. It didn't really help my depression but it did seem to help the anxiety a bit.I was on the Nardil for almost 4 month... go up to 90mg/day... had terrible orthostatic hypotension, was not able to climb stairs without having a blackout, dizness, vertigo and tinnitus... at some point I had visual hallucination on it! I find it really not good for the anxiety... and it was so sedating... but no hypertensives crisis on the Nardil...like the big ones I had on the Parnate.
Why i'm a lot concern about my heart... the answer is simple... When I was on the Parnate, I realise that it was possible for me to die from an heart attack, i'm not 20yo now, i'm 33 yo, and i'm not in a great shape physically, I smooke, I don't eat very well, I had a surgery to loose weight in 2001, so I had morbid obesity for years and years who probably didin't help to have a good heart...
We are all different... I have a fear of dying... you know that's simple, i'm affraid to die because I don't know what happen after. Peoples with high state of anxiety normally like to have the control over their life and dying or having a heart attack will mean that I loose the control over myself and that I will face the unknow... that's why I have a heart obsession...
But mostly, the Parnate is responsible of that phobia... because before the Parnate, I never think about my heart pressure or pulse rate.
Also, I know you said you don't want to go on tricyclics but something like Clomipramine might eventually help you, I did get a lot of anxiety on it initially but after about five weeks that subsided.
>I was put on the Clomipramine in march 2009, start at 20mg day... increase at 50mg day the week after... it was one of the worse experience I had, with the Parnate... The side-effects are very scary... I was not into a high anxiety state like I am now... I can't imagine returning on that med now!!! If I can't tolerate a simple SSRI, I doubt that I will be able to tolerate a TCA!!! Even at low dose...
In June 2009, I was put on the Imipramine (Tofranil) at 25mg... I was in the begining of my high anxiety state with a lot of panic attacks a day... Had a terrible reaction from my heart... increase blood pressure and high pulse rate, who was not anticipatory anxiety effect or panic... Was not able to stay on it for more than 5 days...
I also try the Nortriptilyne (Pamelor), start also at a very low dose of 20mg... Had a worse heart reaction than the one I had on the Imipramine. Pulse rate of 160 beat minute... had to call my PDoc in emergency and ask if it was normal... and no it was not normal... So I stop it after 2 doses only...
Same thing happen with the Cymbalta and the Pristiq... high blood pressure and fast pulse rate...
I try all of this in 2009... maybe if I tried them before the Parnate, I will never experienced these heart effects??? Who know...
> I really hope you can find something for this anxiety. Please keep us updated.
>
>
> DeniseWell I hope also. Next step will probably be only some Lamictal... no AD for now... will just see what it's doing on me... never be on a mood stabiliser before... maybe it will help with my anxiety... if not, I will have to ask to be hospitalised to start a treatment on an AD... since I can't do it alone at home...
Thanks a lot for your answer ;-)
Have a nice day !
Vincent ;-)
Posted by Meltingpot on January 11, 2010, at 14:08:53
In reply to Re: SSRI with the less initial increase anxiety..., posted by Vincent_QC on January 11, 2010, at 8:31:47
Vincent,
Believe me I too know what real side effects are from SSRIs, I experienced terrible anxiety on Remeron, Seroxat, prozac and Sertraline when I started on the drug merry go round in 2001, the anxiety would last all day and I would feel weak from it in the evening. Fortunately the Zyprexa was a God send for me which is why it is such a shame it hasn't helped you.
I know you had a problem with the clomipramine but I'm sure if you had got up to five weeks on it you would have been ok. But then you don't seem to have the reassurance of having something to help with the anxiety.
When you are not on SSRIs and are not experiencing side effects but still experiencing anxiety, do the physical symptoms come first before the anxious thoughts or is it the other way around?
I used to be very scared of dying before my depression and anxiety resurfaced but I no longer am so much as I can't think of a worse state to be in than the way I feel off all medication. I'd rather be dead than have to live like that for the rest of my life. I'm older than you so maybe that also has something to do with it. However, we all have to die sometime and we were all dead for millions of years before we were born, at least I think we were, so we are just going back to the same state as before. Then again if I was close to death then I'm not sure I would feel the same way ;-) I'm wondering if you are a Catholic though, I am.
What about beta-blockers have you tried them along with tricyclics, they are supposed to help with heart rate and blood pressure. Maybe you could ask your doctor if it would be safe to try them along with an antidepressant.
Hope you feel better soon.
Denise
Posted by Vincent_QC on January 12, 2010, at 8:46:12
In reply to Re: SSRI with the less initial increase anxiety..., posted by Meltingpot on January 11, 2010, at 14:08:53
> Vincent,
>
> Believe me I too know what real side effects are from SSRIs, I experienced terrible anxiety on Remeron, Seroxat, prozac and Sertraline when I started on the drug merry go round in 2001, the anxiety would last all day and I would feel weak from it in the evening. Fortunately the Zyprexa was a God send for me which is why it is such a shame it hasn't helped you.
>The main problem with the antidepressant avaible in the Canada or the USA is that they block the reputake of a lot of receptors, who lead to an increase level of those neuroceptors and a terrible increase of the anxiety at first...
In the Europe, they have some antidepressants meds who seem to be a lot smarter than the ones in the USA or Canada like the Stablon (Coaxil) or the newer Valdoxan... 2 meds that I will not be able to try, unless I order them from the web... and even, I don't trust online order and don't know if it can be possible to do it...
Also, like I wrote before, the Zyprexa will decrease your anxiety because it's hit really hard the H1 receptor, who mean that you will feel sedated... so more relaxed (in theory)... but will also make you gain weight very fast and affect your cognitive abilities as well...
In my case, I don't find those kind of meds helping at all... they just mask the anxiety and make me a lot more tired, mean more irritable and anxiety always return in a higher state after they stop working...
Also, I already take the Klonopin (Rivotril - Clonazepam) to a high dose everyday. 8 mg a day is a really strong dose... so every meds who works on the Gaba receptors will not be very usefull also since it's seem that my gaba system is already saturated of more gaba_a neurons and even if I take more if Klonopin, I will not feel less anxious...
> I know you had a problem with the clomipramine but I'm sure if you had got up to five weeks on it you would have been ok. But then you don't seem to have the reassurance of having something to help with the anxiety.
The TCA'S are dirty meds... they hit too many receptors for nothing... and they are toxic for the heart. Most of the peoples on those meds will not notice the high blood pressure and the higher pulse rate while they will be on those meds... but in a long term view, they are the worse meds for the heart.
Also, I don't think adding a beta-blocker will help... since all the TCA's increase the blood concentration of the beta-blocker, making them very dangerous to use at the same time...
Just one more thing on the Beta-blocker... I try a lot of them... they never help as well... it's adding fatigue for nothing, and don't prevent the rapid heart beat, who is responsible of the panic attacks most of the time for me!!!
I try also an older anti-hypertensive drug call "Clonidine"...because I had read some studies about it and the panic disorder and it didn't help at all, I had more panic attacks while I was taking it...
And no, I don't have a good support from my PDoc or anyone else. I don't work so I don't have the money to pay for a private Therapist for a CBT, I Can't have a free therapy because the wating list in here is very long...and most of the time, all the PDoc didn'T seem to care about their patients at all... they just RX meds and return you to home and forget about you...
>
> When you are not on SSRIs and are not experiencing side effects but still experiencing anxiety, do the physical symptoms come first before the anxious thoughts or is it the other way around?
>My anxiety is always there... From the moment I open my eyes in the middle of the night , until I close them when I go to the bed... It's not a matter of thoughts now, it's always there. Before, I had mostly panic attacks trigger by some physical symptoms like the rapide heart beat... or the dizness... but now it's 24h on 24 h...
But, the anxiety is there before the physical symptoms for sure... the symptoms just amplify the anxiety...
> I used to be very scared of dying before my depression and anxiety resurfaced but I no longer am so much as I can't think of a worse state to be in than the way I feel off all medication. I'd rather be dead than have to live like that for the rest of my life. I'm older than you so maybe that also has something to do with it. However, we all have to die sometime and we were all dead for millions of years before we were born, at least I think we were, so we are just going back to the same state as before. Then again if I was close to death then I'm not sure I would feel the same way ;-) I'm wondering if you are a Catholic though, I am.
>No, i'm not Catholic... my family are but not me.... I don't believe in God or anything else and I don'T think believing in something like GOD will help me to have less anxiety from the death and the unknow... I see my grand-mother pray all her life and she die from the cancer in a very painfull situation and distress!!! You know what I mean?... Religion will certainly not help me... and I will stop talking about religion because I feel that I will be ban from here if I don't stop !!! lol
> What about beta-blockers have you tried them along with tricyclics, they are supposed to help with heart rate and blood pressure. Maybe you could ask your doctor if it would be safe to try them along with an antidepressant.
>Like I write before, they don't help... Propanol, Bisoprolol, Metoprolol, name them... I try all of them without any success in reducing my panic disorder... Also, being on a beta-blocker just worse everything because you canno't exercise because of the terrible fatigue and muscles pain they produce. Most of the time, when you are on a beta-blocker, you feel just like you will die because you feel weak and you have a lot of dizness and no physical strenght...
Beta-blocker are only good for peoples with real heart disease... they don't even help for the situational exposure anxiety like when it's time do to a public speech...
> Hope you feel better soon.
>
>
> Denise
>
>I hope also....
>
>
Posted by Sigismund on January 12, 2010, at 15:17:51
In reply to Re: SSRI with the less initial increase anxiety... » Meltingpot, posted by Vincent_QC on January 12, 2010, at 8:46:12
Vincent, what about this?
Posted by gman22 on January 12, 2010, at 20:23:37
In reply to SSRI with the less initial increase anxiety..., posted by Vincent_QC on January 10, 2010, at 12:13:01
I would maybe try gabapentin and start on clomipramine low dose and work it up gradually. TCA's are not bad for the heart. Thier safety index is probably better than that of tylenol. Many people have been on them for 40 years or more, and a lot of them are elderly.
You seem have some OCD symptoms, which clomipramine would help.
The problem is that it can suck getting up to a therapuetic dose and it takes time. Maybe the gabapentin would help with the side effects.
This is the end of the thread.
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