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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 Mtom on August 28, 2018, at 15:49:00
Hypersensitive to side effects (as mentioned in past), so start with ultra low doses and titrate dose up very slowly. Tried Citalopram for 2 1/2 months & then switched last month to Escitalopram - again very small doses. With both became extremely anxious/agitated within a few days which lasts for weeks, and increases again after each tiny dose increase (which I do when I "think" the anxiety is starting to abate a bit, but not totally gone). Other side effects include fatigue (need day nap), loss of appetite, Tinnitus (and a few vivid bad nightmares). Wondering if effecting quality of my night sleep, adding to the fatigue.
Taking too long to get to a therapeutic dose with months of anxiety (which was pre-existing but became significantly worse, slightly more so with Citalopram which is why the switch is es-C), even with anti-anxiety med to help somewhat. Have in past tried other AD's which were even worse and my Genetic Testing (which had much more limited info than expected) indicated these were 2 good choices for me. My Pharmacist says Escitalopram in his experience fewer side effects and better efficacy than Citalopram. Not seeing this yet. (although escitalopram has been just 4 1/2 weeks of very low dose - still trying to titrate slowly).
Running out of options. Has anyone had to push through weeks of side effects? Difficult to get up to a therapeutic dose with these going on.
Tinnitus seems to be improving but also unfocussed all the time (might be in part due to the depression, but seems worse since starting AD's)
Posted by linkadge on August 29, 2018, at 7:23:22
In reply to titrating slowly but anxiety increases. Thoughts?, posted by Mtom on August 28, 2018, at 15:49:00
What dose are you on? How quickly have you been increasing?
Linkadge
Posted by Christ_empowered on August 29, 2018, at 7:30:48
In reply to titrating slowly but anxiety increases. Thoughts?, posted by Mtom on August 28, 2018, at 15:49:00
maybe antidepressants just aren't for you. what symptoms go with your depression? what other psych drugs have you tried?
the 1st thought that came to my mind was gabapentin and a low dose 'atypical,' or perhaps even buspirone (buspar). just a thought...im clearly not prescribing to anybody, lol.
antidepressants aren't a good fit for a lot of people.
Posted by Mtom on August 29, 2018, at 9:57:47
In reply to Re: titrating slowly but anxiety increases. Thoughts?, posted by Christ_empowered on August 29, 2018, at 7:30:48
My Genetic testing showed an issue with my CYP2D6, a P450 enzyme involved with metabolism of most antidepressants and all antipsychotics. I have 1 active allele & 1 inactive/nonfunctional allele. Genetic research is controversial and contradictory on what this means as far as clearance of these drugs (e.g. whether clearance is slowed by the inactive allele, or if the active allele counteracts this). The report however was clear that the sources they used for Antipsychotics (they used a variety of sources based on levels of evidence) indicated I would have reduced metabolism of this class of meds with increased risk of adverse drug reactions including tardive dyskensia. The difference source they used for antidepressants classify me as a normal metabolizer despite the inactive allele. My follow up conversations with them to clarify confirmed that my CYP2D6 alleles put me in a "contested" category and they choose the best levels of evidence they can find on each drug (which is limited & often poor quality), from various sources - so they can't comment further on the anomalies until more research is done. (and how many people are really getting funding for this type of research?)
Citalopram and Escitalopram are believed to be "mostly" metabolized by CYP2C19 for which my alleles are "normal". They may also be partly metabolized by CYP3A4, which the Genetic Company did "not" include in their tests due to lack of research. Some papers "believe" that CYP2D6 also plays a role in escitalopram metabolism, but research is little & inconsistent.
In years past I tried Zoloft, low dose amitriptyline, and very very low doze Trazodone (for sleep issues) and had intense side effects, extreme with Trazodone and especially with Zoloft after just 1 dose. Trazodone is metabolized by CYP3A4 which they did "not" test for so possible this could be an issue for me. Amitriptyline and Zoloft at least partially metabolized by my "controversial" CYP2D6.
I don't like what I read about gabapentin for side effects.
It appears I will have to stick it through a few more weeks titrating slowly with escitalopram.
I am also looking into rTMS, but that is a whole other discussion.
> maybe antidepressants just aren't for you. what symptoms go with your depression? what other psych drugs have you tried?
>
> the 1st thought that came to my mind was gabapentin and a low dose 'atypical,' or perhaps even buspirone (buspar). just a thought...im clearly not prescribing to anybody, lol.
>
> antidepressants aren't a good fit for a lot of people.
Posted by Fred23 on August 29, 2018, at 13:32:57
In reply to titrating slowly but anxiety increases. Thoughts?, posted by Mtom on August 28, 2018, at 15:49:00
Are you using name brand or generic?
Posted by Mtom on August 29, 2018, at 14:03:17
In reply to Re: titrating slowly but anxiety increases. Thoughts?, posted by Fred23 on August 29, 2018, at 13:32:57
Brand name. The 1st month of citalopram were generic then switched to brand name for 7 weeks (Celexa in Canada). Very low doses, titrated up just once due to intense anxiety/agitation. Switched to brand name escitalopram a month ago (Cipralex in Canada, same as Lexapro, don't know why different name). Again low doses, titrating up (recently taking 5 mg, goal is 10 mg due to my sensitivities and metabolism (read post re Genetic Testing).
> Are you using name brand or generic?
>
Posted by Fred23 on August 29, 2018, at 14:52:21
In reply to Re: titrating slowly but anxiety increases. Thoughts?, posted by Mtom on August 29, 2018, at 14:03:17
Has your doctor considering using a benzo at least temporarily to offset the anxiety/agitation?
Posted by Mtom on August 29, 2018, at 15:32:42
In reply to Re: titrating slowly but anxiety increases. Thoughts?, posted by Fred23 on August 29, 2018, at 14:52:21
Oh yes, that was necessary, and I was also having concurrent anxiety with the depression before, another reason for Escitalopram, to treat both. The Benzo only helps a bit though (at least at the dosage I'm taking which is moderate, she doesn't want to go higher, and neither do I).
Still hoping the escitalopram will kick in, maybe after my next titration, and side effects will go away.
> Has your doctor considering using a benzo at least temporarily to offset the anxiety/agitation?
>
Posted by beckett2 on August 29, 2018, at 15:35:37
In reply to Re: titrating slowly but anxiety increases. Thoughts?, posted by Fred23 on August 29, 2018, at 14:52:21
> Has your doctor considering using a benzo at least temporarily to offset the anxiety/agitation?
>Lyrica is not often prescribed, but it might help, not only with anxiety, but uncomfortable physical sensations. It is less addictive than a benzodiazepine if taken for a month or so-- at least that is my experience.
Posted by bleauberry on August 31, 2018, at 6:58:42
In reply to titrating slowly but anxiety increases. Thoughts?, posted by Mtom on August 28, 2018, at 15:49:00
Your story sounds exactly like mine was. I eventually got a very late diagnosis of Lyme. A few years of treatment with antibiotics and herbs corrected most of it. Psychiatric meds only made it more difficult and often worse.
Whenever I hear someone complain of being overly sensitive to tiny doses, I immediately think Lyme. My journey was long and deep and taught me things like that. Personal experience as well as literally 1000s of hours of research.
My first LLMD (Lyme Literate M.D.) (family docs and infectious disease specialists are ill equipped to make accurate diagnosis or treatment, believe it or not, sad) first LLMD treated depressed patients with Lexapro liquid - he started with one drop - which is the same as 1/10th of 1mg. His patients often ended up feeling better on doses in the 1mg to 5mg range. That is typical of Lyme patients, who either need extremely small doses or extremely large doses, but hardly ever normal doses.
That particular doc does that all day every day with all of his patients and it works for him. I just wanted to share that so you could ponder that, think about it.
You can get immediate relief to anxiety - half hour wait - with capsules of these herbs: Lemon Balm, Passionflower, Skullcap, Valerian. You can get good longterm cure of anxiety with Rhodiola Rosea, other adaptogens such as Eleuthero and Ashwagandha, and anti-Lyme treatments eventually smooth things out too.
If you've been suffering months then all I can say is your doctor is doing a lousy job. You either need a different one who can manage this situation with more skill, or you need a whole new approach that is not exclusively antidepressant prescriptions.
If I were you I would check around on google to see if you can find any LLMDs in your area. There aren't that many, maybe half dozen or so in every state. But those guys deal with the stuff psychiatrists fail at. My LLMD took 20 years of my treatment resistant major depression - that even failed ECT - and he turned that into remission in 3 years. He did that with antibiotics and herbs, not with psych meds.
...back to the herbs....those four herbs can be combined any way you like....solo, duo, trio, whatever....try each individually to get familiar with how they feel first....
> Hypersensitive to side effects (as mentioned in past), so start with ultra low doses and titrate dose up very slowly. Tried Citalopram for 2 1/2 months & then switched last month to Escitalopram - again very small doses. With both became extremely anxious/agitated within a few days which lasts for weeks, and increases again after each tiny dose increase (which I do when I "think" the anxiety is starting to abate a bit, but not totally gone). Other side effects include fatigue (need day nap), loss of appetite, Tinnitus (and a few vivid bad nightmares). Wondering if effecting quality of my night sleep, adding to the fatigue.
>
> Taking too long to get to a therapeutic dose with months of anxiety (which was pre-existing but became significantly worse, slightly more so with Citalopram which is why the switch is es-C), even with anti-anxiety med to help somewhat. Have in past tried other AD's which were even worse and my Genetic Testing (which had much more limited info than expected) indicated these were 2 good choices for me. My Pharmacist says Escitalopram in his experience fewer side effects and better efficacy than Citalopram. Not seeing this yet. (although escitalopram has been just 4 1/2 weeks of very low dose - still trying to titrate slowly).
>
> Running out of options. Has anyone had to push through weeks of side effects? Difficult to get up to a therapeutic dose with these going on.
>
> Tinnitus seems to be improving but also unfocussed all the time (might be in part due to the depression, but seems worse since starting AD's)
This is the end of the thread.
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