![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by TriedEveryMedication on September 3, 2010, at 20:34:21
been taking 10-15mg of lexapro for the past 3 or 4 weeks.
Sometimes I wake up in the middle of the night feeling quite panicky.
I'm also taking 10mg of adderall XR, but that has never made me feel panicky by itself and during the day I feel fine. I think the adderall has worn off by about 3pm.
It seems odd that lexapro would do this. I hope I'm not bipolar...Thanks
Posted by Phillipa on September 3, 2010, at 20:41:56
In reply to Can lexapro cause panic attacks?, posted by TriedEveryMedication on September 3, 2010, at 20:34:21
Sometimes you need a benzo. Why would you think you are bipolar? Phillipa
Posted by TriedEveryMedication on September 3, 2010, at 21:28:03
In reply to Re: Can lexapro cause panic attacks? » TriedEveryMedication, posted by Phillipa on September 3, 2010, at 20:41:56
Hi Phillipa,
Paradoxically, benzos make me agitated.
I was diagnosed as ADHD-I, with depression, but my doctor sometimes thinks it could be bipolarII.
I've read that ssris can cause mania.
Posted by Phillipa on September 3, 2010, at 21:46:42
In reply to Re: Can lexapro cause panic attacks? » Phillipa, posted by TriedEveryMedication on September 3, 2010, at 21:28:03
Some do have paradoxical reactions. Why does your doc think bipolar if to a med as remove the med and no symptoms right? So what's he/she thinking of adding? Phillipa
Posted by morgan miller on September 3, 2010, at 22:11:49
In reply to Can lexapro cause panic attacks?, posted by TriedEveryMedication on September 3, 2010, at 20:34:21
Lexapro can cause panic and anxiety. I don't think you are having a bipolar reaction. You are only a few weeks into it. SSRIs like Lexapro may cause severe anxiety before your body adjusts and the medication has time to start working. It may end up that Lexapro is just too powerful for you or that you will do better on a lower dose.
Posted by morgan miller on September 3, 2010, at 22:17:18
In reply to Can lexapro cause panic attacks?, posted by TriedEveryMedication on September 3, 2010, at 20:34:21
I would just stay on 10 mg and not go higher for another month and see what happens.
Posted by SLS on September 4, 2010, at 5:58:55
In reply to Re: Can lexapro cause panic attacks?, posted by morgan miller on September 3, 2010, at 22:11:49
> Lexapro can cause panic and anxiety. I don't think you are having a bipolar reaction. You are only a few weeks into it. SSRIs like Lexapro may cause severe anxiety before your body adjusts and the medication has time to start working. It may end up that Lexapro is just too powerful for you or that you will do better on a lower dose.
Yes, anxiety can be a reaction to Lexapro. In my experience, it seems to be time-dependent. It appeared by day 14 and disappeared by day 21. I have heard of others experiencing this same pattern.
- Scott
Posted by TriedEveryMedication on September 4, 2010, at 12:57:24
In reply to Re: Can lexapro cause panic attacks?, posted by SLS on September 4, 2010, at 5:58:55
Posted by jms600 on September 4, 2010, at 16:32:05
In reply to Re: Can lexapro cause panic attacks?, posted by morgan miller on September 3, 2010, at 22:17:18
I'm also on Ciprales (Lexapro in US) - have been on it for around a 5 weeks now. For some reason, my anxiety seem to increase a lot around week four. I'd have though that I would have adapted to the drug at that stage. Nonetheless my anxiety and panic increased for no apparent reason at all - apart from the medication!
Posted by Vincent_QC on September 10, 2010, at 6:00:57
In reply to Re: Can lexapro cause panic attacks?, posted by SLS on September 4, 2010, at 5:58:55
> Yes, anxiety can be a reaction to Lexapro. In my experience, it seems to be time-dependent. It appeared by day 14 and disappeared by day 21. I have heard of others experiencing this same pattern.
>
>
> - ScottHummmm hummmm... Before I try too many meds for my social phobia, I never had any problem with increase anxiety with simple meds like the SSRI's...
BUT, now that I try everything, including dangerous meds like the Parnate who lead to hypertensives crisis or meds like Mirapex to boost my dopamine level, my life completly change.
Now, 1 mg of Lexapro is enough to put me in state of panic for 24 hours. It's like my brains, especially serotonin and noradrenaline receptors are hypersensible to all the meds and i'm having overactive reactions on them.
I try to be back on the Cipralex (Lexapro in the USA) last january and I do only one day at 1 mg... I had fast pulse rate, irregular pulse rate as well aa panic attack, tinnitus, dizziness and others side-effects that I cant recall for 24 hours.
Back in 2008, I was on 30 mg of Lexapro and never had anxiety problem with it. I was just lazy with no motivation, gain a lot of weight and had to take stimulants meds with it to wake me up(Ritalin 15 mg + Wellbutrin 300 mg + Lexapro 30mg + a lot of coffee)... that med fail to reduce my social phobia and agoraphobia...like the Celexa , the Prozac or the Zoloft, they all fail to reduce my social phobia, as well as all the Tryciclics meds or the Nardil, Parnate, beta-blocker or Clonidine and the benzo meds... They all fail.
I now think that social phobia is more a personnality problem than a chronic disorder and no pill can fix it, just therapy...
But now with all those meds I took, I have some dammage in my brains and i'm now stuck with extreme panic disorder with chronic anxiety symptoms who are on 24 hours a day (tension headache, chest pain, numbness feeling in the left arm, dizziness, fast or too slow pulse rate and irregulart heart beat, sensitivity to lights and noise, tinnitus, extreme agoraphobia (can't go out of the house or drive without having panic)...
Now i'm trying to be back on the Paxil, the only one SSRI who work to block the panic attack on me. Was able in the past to tolerate more than 40 mg/day without any side-effect.
I start it at 0.3 mg/day last sunday, the liquid form is not available in the Canada, so I have to cut the 20 mg pill into small 2,5 mg piece and crush it into powder and add oil that I previously measure and blend it very well and take it with a syringe for the right dose. I increase it by 0,1 mg each day and of course I have side-effects.
Can you imagine how long it will be to reach the 15 mg dose, who is the minimum effective dose for me?
And at only 0,6 mg/day, I have side-effects... The starting dose is 10 mg... can't imagine to start it at 10 mg now, too bad cause in the past 20 mg was my starting dose and I never had side-effect.
The side-effects I have at only 0.6 mg are mainly increase anxiety, sweating, depersonalization/irreality feeling, insomnia, irregular heart beat with chest pain, dilated pupils of the eyes...and the list goes on... Ok, I have those chronic anxiety symptoms all the time now, Paxil or not, but on the Paxil they are increase my 10% at least.
So yes, Lexapro can cause panic attacks, don't be surprise or afraid, maybe a reduction of the dose to 5 mg will be a good idea?
Posted by Conundrum on September 10, 2010, at 6:21:49
In reply to Re: Can lexapro cause panic attacks?, posted by morgan miller on September 3, 2010, at 22:17:18
> I would just stay on 10 mg and not go higher for another month and see what happens.
>
>I agree here. 10mg or even 5 mg might be better. Also if your doc feels you might be somewhere on the BP spectrum you might try lamictal if you haven't. Don't get the Dr. Reddy - TARO generic though. Try to get Teva if you try it. It is supposed to work as an antidepressant at lower doses.
Posted by emmanuel98 on September 10, 2010, at 19:36:41
In reply to Re: Can lexapro cause panic attacks? » morgan miller, posted by Conundrum on September 10, 2010, at 6:21:49
It sounds like you are in an almost constant state of anxiety and worry about your body. Have you ever tried a benzo for this? Also, I think therapy would be very helpful for your social phobia and also for your anxiety. You could learn some skills to manage your fears.
Posted by TriedEveryMedication on September 10, 2010, at 19:48:16
In reply to Re: Can lexapro cause panic attacks?, posted by emmanuel98 on September 10, 2010, at 19:36:41
Posted by morgan miller on September 10, 2010, at 20:25:44
In reply to CBT made me much worse, actually. (nm) » emmanuel98, posted by TriedEveryMedication on September 10, 2010, at 19:48:16
Many forms of therapy may make you feel worse before you get better. That's the point of therapy, to face your fears, deal with your demons, then, once you do, you begin to heal and your mind and psyche begin to operate better. Therapy is not easy or a quick fix, it requires hard work and time.
Posted by morgan miller on September 10, 2010, at 20:27:32
In reply to Can lexapro cause panic attacks?, posted by TriedEveryMedication on September 3, 2010, at 20:34:21
How are things on Lexapro? The earlier suggestion to lower it to 5 mg is a good one. You may actually do very well just staying on 5 mg for good, without having to raise the dose. Lexapro is a powerful drug.
Posted by violette on September 12, 2010, at 12:01:41
In reply to Re: CBT made me much worse, actually. » TriedEveryMedication, posted by morgan miller on September 10, 2010, at 20:25:44
TriedEveryMedication,
I'm curious as to how cbt made you worse off, if you don't mind sharing..thanks. This is something i'd like to see researched in ways that i haven't seen....and i'm trying to get a better picture of what the problem is with those unresponsive to cbt other than what i've seen already researched..
Morgan,
I understand how therapy can make you worse before better...but wanted to mention my experience with CBT...and that of others who i speak to...
i was not worse during-i was worse after. it strenghthened the defense mechanisms I was already using-it did not integrate my emotions w/ self, it encouraged emotionally distancing myself from them...i had already known at the cognitive level what my issues were-low self worth, etc., but didn't feel it so much at the emotional level due to the defenses I was using. cbt strenghthened compartmentalized thinking-a maladaptive trait. But this trait is better than some of the others for emotional regulation and other issues.
This is common with other people i've spoken with who have attachment issues, but have adaptively used a mix of defense mechanisms, a range of unhealthy and healthy ones... cbt can help you temporarily if you tend to use some of the lower level defenses more often..imo. But integrating the emotions with your self strenghthens the self = healthy sense of self = automatic ego regulation, one of the psychological components of MI that psychoanalytic therapy addresses and cbt does not.
Another common issue i hear is that cbt can be harmful with those who already have harsh superegos-which includes a range of disorders...it tells you that your thinking is faulty, and that you need to change...not good for those with attachment issues or who otherwise have harsh superegos. it can strengthn your inner critic in that way-making one worse off than before.
dbt seems to be a good step up from cbt, for those with more impulse control realted issues, and also can improve the superego-inner critic-from what i read and heard about it...
Posted by violette on September 12, 2010, at 12:38:08
In reply to Re: CBT made me much worse, actually. *ME TOO*, posted by violette on September 12, 2010, at 12:01:41
This website mentions (briefly) one of those problems i've seen. There is a link at the bottom of the page which describes key concepts of cbt and psychodynamic. Might be helpful for some to read; on that page, there is a link to 4 therapists' overall views, from both orientations. What i've read here seems fairly unbiased..though don't know who runs the site.
This could be related to what i said earlier:
"Others find they dont like the way CBT downplays emotions while seemingly overemphasizing the logical and thought-oriented components of one's mental life."
If you already tend to do this through using defenses at the medium-healthy level - intellectualization and rationalization - related to compatmentalized thinking/compartmentalizing emotions, how's it gonna help change your inner state, leaving emotions unintegrated with the psyche? Anyway, here's where that came from:
CONS of CBT
While some people find CBT helpful, others dislike it, feeling they are being talked out of their emotions. Some find that CBTs focus on positive thinking feels too superficial to them, minimizing the importance of their personal history. Others find they dont like the way CBT downplays emotions while seemingly overemphasizing the logical and thought-oriented components of one's mental life. Still others find they dont get the results they desire with CBT and find that while psychodynamic therapy is more of an investment, it is more effective for them.
Posted by emmanuel98 on September 12, 2010, at 19:34:37
In reply to Re: CBT made me much worse, actually., posted by violette on September 12, 2010, at 12:38:08
I think CBT is good for certain disorders, not others. In a situation like Vincent's, just having someone to reassure him that he will not die, is not having a heart attack, can manage his anxiety and to give him constructive exercises to manage panic would be most helpful. Dynamic therapy isn't much use to people who are in the throes of deep anxiety and panic. The symptoms need to be dealt with first. CBT is very helpful for panic attacks and for OCD. Not so good for other things.
When I've been hosptialized we did a lot of CBT groups and I also felt like they were saying -- you just need to snap out of it. If I could have snapped out of severe depression, I wouuld have and I was hard enough on myself and my friends and family were urging me to just snap out of it, so I didn't find CBT very helpful for that at all.
Posted by violette on September 12, 2010, at 21:28:39
In reply to Re: CBT made me much worse, actually., posted by emmanuel98 on September 12, 2010, at 19:34:37
Yeah i get what you're saying emmanual..was wondering how it made TEM worse; it's just something i'm interested in...i did not read the other posts in this thread...
I've had panic attacks for decades; when it was addressed in cbt-i'd get panic attacks in session. But mine are related to attachment issues, childhood trauma...my therapist does not react to my anxiety; he contains it.
Maybe cbt is better for non-attachment anxieties,..but if your ocd/panic is related to attachment trauma, imo you need relational psychotherapy-which CBT is not. This is not just from my experience; from research-attachment wounds are healed through an attachment relationship/psychodynamic.
Posted by TriedEveryMedication on September 14, 2010, at 12:32:47
In reply to Re: CBT made me much worse, actually. *ME TOO*, posted by violette on September 12, 2010, at 12:01:41
hi violette,
I had 16 sessions of CBT that included mock interactions/exposure with interns.
It seems like the exposure made me worse - the more exposure to social situations I had, the more withdrawn I became.
after the sessions, I started doubting the main premise of CBT - that thoughts lead to emotions. I've never seen any empirical evidence presented for this.
In fact, I've seen a lot of evidence presented in other fields (behavioral economics) that suggests emotions lead to thoughts.
I still don't entirely know what went wrong with the CBT though.
> TriedEveryMedication,
>
> I'm curious as to how cbt made you worse off, if you don't mind sharing..thanks. This is something i'd like to see researched in ways that i haven't seen....and i'm trying to get a better picture of what the problem is with those unresponsive to cbt other than what i've seen already researched..
>
Posted by sigismund on September 14, 2010, at 18:05:12
In reply to Re: CBT made me much worse, actually. *ME TOO* » violette, posted by TriedEveryMedication on September 14, 2010, at 12:32:47
>I started doubting the main premise of CBT - that thoughts lead to emotions. I've never seen any empirical evidence presented for this.
>In fact, I've seen a lot of evidence presented in other fields (behavioral economics) that suggests emotions lead to thoughts.
That's how I think it works. Maybe I just assumed it, I don't know.
Posted by violette on September 14, 2010, at 20:50:47
In reply to Re: CBT made me much worse, actually. *ME TOO* » violette, posted by TriedEveryMedication on September 14, 2010, at 12:32:47
> In fact, I've seen a lot of evidence presented in other fields (behavioral economics) that suggests emotions lead to thoughts.
Hi TEM,
I've seen this as well-in many disciplines/businesses (i.e. strategy, org psychology, legal, etc). I think you can control your emotions with thoughts to a certain extent, it's basically building more defense mechanisms against emotions, imo, seperating yourself further from your emotion, which equals more problems in the long run.
I already had been having panic attacks when in CBT therapy, but when my therapist addressed my anxiety, it escalated to full-blown panic attacks in session. For me, this is because my anxiety is related to my childhood attachment (i didn't know this at the time). Since then, I learned anxiety is often related to childhood development for other people too.
Through projective identification with a psychodynamic therapist, the anxiety was bordering on panic the whole time-but did not escalate to panic. Totally different outcome..the T serves as a container for the anxiety, then projects his calm position/soothing reaction back to you...you then internalize it yourself-your ability to not lose control, which translates to self soothing capacity..much like a strong-minded mother soothing a baby in turmoil.
It sounds funny when you read about projetive identification, but when you experience it yourself, it's fascinating.
...usually don't get anxiety at that level during sessions, this is still new, so I'll have to wait and see how it turns out in time.
Thanks for letting me know how it worked for you!
Posted by Vincent_QC on September 15, 2010, at 15:04:47
In reply to Re: CBT made me much worse, actually. » TriedEveryMedication, posted by morgan miller on September 10, 2010, at 20:25:44
> Many forms of therapy may make you feel worse before you get better. That's the point of therapy, to face your fears, deal with your demons, then, once you do, you begin to heal and your mind and psyche begin to operate better. Therapy is not easy or a quick fix, it requires hard work and time.
>
>That's so true!!!
I'm doing 2 therapies at the same time right now and it's very difficult...
With the cognitive therapy (exposure to fears and symptoms), I see an increase in the frequency of my panic attacks and also stop going out of the house, drive my car and I feel all the time sick... So I can't practice the exposure because of the symptoms and fears, but will have no choice to face them if I want to heal...
For the other therapy, it's new for me and another way of work, more linked to negatives emotions and negatives thoughts who lead to anxiety symptoms(most of the time it's an unconscious process).
Of course, therapy will not give results if you stay in your house and don't practice or face your fears every days or change your negatives thoughts or forget the past and the traumatic events you live in the past... and always think about those negatives events...
If I don't see results with the therapies i'm doing right now, it's because most of the time i'm stuck with my negatives thoughts, the past, and always find 10000 bad excuses to not do my exposure and face my fears.
That's not mean that I don't want to heal, that's just mean that maybe i'm not ready to change some bad habits in my life or lack the strenght to do it...
That's not easy to get into action when you face so many anxiety symptoms each day of your life and it's helping me to see no positive results from the therapy, even after 3-4 months and yes sometimes I feel hopeless because I do all what I can to understand my problems and the emotions behind them but I see no positives results...
So yes it's hard work and it take time... but I try to not feel guilty because it's not working right now, it will work with time for sure... Anxiety don't build up in me in 1 day... I was anxious for most of my life, so that's normal that I will not heal in 1 week... Have a lot of things to fix...so I do it one step at the time...
Posted by morgan miller on September 15, 2010, at 15:19:52
In reply to Re: CBT made me much worse, actually. » morgan miller, posted by Vincent_QC on September 15, 2010, at 15:04:47
>So yes it's hard work and it take time... but I try to not feel guilty because it's not working right now, it will work with time for sure... Anxiety don't build up in me in 1 day... I was anxious for most of my life, so that's normal that I will not heal in 1 week... Have a lot of things to fix...so I do it one step at the time...
Well you sound like you have a good understanding of yourself and awareness of what it will take for you to get better. It definitely takes quite some time to really make progress. I think it's great that you are trying to be patient with yourself and not giving yourself a hard time for not getting better straight away. Sounds like your on the right track. One thing I would suggest is to focus on those things that are at the root of your fears and negative feelings about yourself. Maybe you are already doing this. The goal is to eventually improve your self image and inner love for yourself. You WILL become stronger if you stay the course and keep working hard. Hang in there.
Morgan
Posted by Simcha on September 15, 2010, at 23:50:00
In reply to Re: CBT made me much worse, actually., posted by morgan miller on September 15, 2010, at 15:19:52
My orientation as a therapist is highly relational and transpersonal. So there's my bias up front.
In actual practice, most therapists have an underlying orientation and can pull in techniques used in other orientations when appropriate. I use cbt and dbt as appropriate. I like using cbt techniques with my empathic style of relational therapy. It gives cbt what I believe it lacks, depth and an acknowledgment that thoughts and feelings are connected and one doesn't necessarily give birth to the other. The human psyche is much more complex in my humble opinion than the vision that cbt portrays.
My bias is that a good therapist can use whatever tools work from no matter what orientation according to each individual client's needs. And the really excellent therapists know when to refer a client to another therapist if you as a therapist aren't able to connect well enough to help a particular client.
Insurance companies love cbt because it's brief and therefore costs them less money. So cbt therapists and insurance companies have partnered to create "evidence" that cbt is the perfect treatment for just about anything. Therefore cbt therapists like to claim that their form of therapy is entirely scientific and "evidence based" and all other forms of therapy are not evidence based. Of course this is all very political and another good illustration of why health care shouldn't be for-profit.
Most of us therapists are for whatever works for any particular client.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.