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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Jaxter99 on August 6, 2023, at 19:54:59
Hi - I used to be on here years ago.
I have agoraphobia (with panic attacks). They used to be well controlled by SSRIs - but the SSRIs had a habit of 'pooping out' on me after about 3 years. After the 4th one failed my pdoc put me back on my first SSRI (paroxetine - I think it's called Seroxat in the UK) along with a low dose of risperidone (0.5mg). That worked really well (I felt almost bullet proof!) while I was only working part time. (My son was quite young at the time, hence the part time work). I only felt tired occasionally, and it was manageable. About 6 months ago I started working full time, and it's almost floored me. I spend half of the weekends napping to recover from working during the week - and it's just a desk job. (I'm a graphic designer). I take the meds at night, but does anyone have any hints on how to mitigate the fatigue? I've talked to my pdoc about it, but he says it's such a low dose of risperidone he can't understand why I'm so tired from it.
I've had full blood count done from my doc twice, so I'm not anaemic or anything like that.
cheers
Jackie
Posted by SLS on August 9, 2023, at 8:54:36
In reply to Really fatigued by risperidone and paroxetine, posted by Jaxter99 on August 6, 2023, at 19:54:59
Both risperidone and paroxetine tend to be sedating or fatiguing. However, 10 people can react to the same drug in 10 different ways.
Regarding paroxetine, I think it is the SSRI most likely to poop-out. For me, risperidone was one of the most sedating of the antipsychotics.
I have seen reports over the years that imipramine (Tofranil), a tricyclic antidepressant (TCA), was effective for agoraphobia (with panic attacks).
https://pubmed.ncbi.nlm.nih.gov/?term=agoraphobia+panic+attacks+imipramine
However, my guess is that clomipramine (Anafrinil) might be even better, as it is thought to be the most effective drug for OCD. Clomipramine is potent as a reuptake inhibitor of both norepinephrine and serotonin. It's sort of a combination of TCA and SSRI. Its side effects include those of a TCA and SSRI. Its anticholinergic side effects seemed rather strong to me, but certainly bearable. Compared to SSRIs, I think clomipramine is less likely to poop-out.
https://pubmed.ncbi.nlm.nih.gov/?term=agoraphobia+panic+attacks+clomipramine
There are some older studies that looked at using phenelzine (Nardil)O for agoraphobia.
https://pubmed.ncbi.nlm.nih.gov/?term=agoraphobia+panic+attacks+phenelzine
I did not enjoy being on either paroxetine or risperidone.One last thing. Paroxetine is extremely difficult to discontinue for some people. Withdrawal symptoms can include the typical SSRI withdrawal effects. In addition, you might experience some cholinergic rebound, which makes it even harder. You will need to taper off of it gradually, but your doctor might elect to start imipramine or clomipramine as you near the end of your taper period. However, you cannot begin taking Nardil until two weeks after your last dose of paroxetine.
- Scott
Posted by Jay2112 on August 15, 2023, at 21:09:21
In reply to Really fatigued by risperidone and paroxetine, posted by Jaxter99 on August 6, 2023, at 19:54:59
Hi Jackie,
I was on Paxil, risperdone, and Adderall (a stimulant) and suffer from agoraphobia as well. The Adderall was amazing for my agoraphobia, suprisingly, and it helped with the fatigue from the Paxil and risperdone. Not sure if your doctor is up to it or not, but Adderall, and Vyvanse are very well tolerated stimulants. (I get bad panic attacks, and they don't increase them if you go with a low dose.)
Any other questions, let me know!
Best,
Jay
Posted by SLS on August 16, 2023, at 7:50:03
In reply to Re: Really fatigued by risperidone and paroxetine » Jaxter99, posted by Jay2112 on August 15, 2023, at 21:09:21
Hi, Jay.
Your observations regarding amphetamine and your improvement in agoraphobia amazes me. It's a perfect answwer to Jaxter's dilemma - even if it doesn't work.
- Scott> Hi Jackie,
>
> I was on Paxil, risperdone, and Adderall (a stimulant) and suffer from agoraphobia as well. The Adderall was amazing for my agoraphobia, suprisingly, and it helped with the fatigue from the Paxil and risperdone. Not sure if your doctor is up to it or not, but Adderall, and Vyvanse are very well tolerated stimulants. (I get bad panic attacks, and they don't increase them if you go with a low dose.)
>
> Any other questions, let me know!
>
> Best,
> Jay
Posted by Jay2112 on August 28, 2023, at 21:46:33
In reply to Re: Really fatigued by risperidone and paroxetine » Jay2112, posted by SLS on August 16, 2023, at 7:50:03
Hi Scott,Yes, and amphetamine has also helped me with severe grief in the past, too. I remember during the winter after my parents passed within a year of each other, and one episode in particular. I had stopped Dexedrine for over a month, and was on just Zyprexa and amitriptyline. I had a very, very terrible 2 days, with tons of snow, and I had to shovel my way out of my parent's large lot, and had fearfully driven the car out into the city to get food and gas. The snow made me fearful I would get trapped somewhere, and something terrible would happen. Well, I did end up blowing a tire in the outskirts, and cellphoned for the Automobile Association to come change my tire. (I was trembling with fear, crying that I wouldn't be able to get home and feed my beloved dog.) The AA arrived, changed the tire, and the technician must have thought I was insane! (I was!! lol). I fearfully navigated home, burst into the house, kissed my dog, and just blew right out into tears. Nothing would stop me crying....and then I decided I MUST take my Dexedrine! I did, and within a half an hour, the tears slowed, and I felt some composure. NOW, I know that sounds eerrily like addiction, but this was very particular to this incident. Otherwise, if I hadn't gone out, I likely would have been fine!
To this day (I now use Adderall) I still take the medication. I have found a trio that works...Adderall, Effexor (150) and Cipralex/Lexapro (20). And, I am also on clonazapam, Lyrica, Risperdal, and Suboxone. Yes, it's a lot of medication, but I meet many clients (I work in a shelter) and read of many on Facebook whom are on similar, if not more meds. I don't care if I had to double it to keep my sanity and happiness. I think the human brain is so complex, many need more than just a few medications. I now have a great job (even if I am still on disability) and am branching out to create some new great relationships. Yes, I still sometimes get tears and scared, but they pass, and I move on.
And....last but NOT least....I have a cancerous skin lesion growing on my face. I could have been so scared to do something stupid. But, with the help of my psychiatrist (he suggested adding the escitalopram since a few years ago, it worked awesome with the Effexor..synergystically, it seems) and my therapist (practicing mindfulness..in the 'here and now'...not yesterday, or tomorrow)..I am doing quite good. My therapist mentioned this last week. Now, with my med combo, I do experience some mild hypomanias, but, they are very controllable. And, I don't have crashing depressions. The hypomania feels good after some very bad depressions. My Risperdal also quashes the hypomania quite good as well.
So, I have surgery (day surgery) on Sept 7th to freeze and cut out the lesion, and hopefully all of the cancer. As well, if it doesn't get all the cancer, they can repeat the procedure.
Yes, I still, in brief spurts, get the darker feeling, but I feel protected...as weird as it sounds. I honestly think it is our mind, our perception that is our worst enemy.
Jay (I am now going to take my Risperdal, and meditate/relax :)
> Hi, Jay.
>
> Your observations regarding amphetamine and your improvement in agoraphobia amazes me. It's a perfect answwer to Jaxter's dilemma - even if it doesn't work.
>
>
> - Scott
>
>
>
> > Hi Jackie,
> >
> > I was on Paxil, risperdone, and Adderall (a stimulant) and suffer from agoraphobia as well. The Adderall was amazing for my agoraphobia, suprisingly, and it helped with the fatigue from the Paxil and risperdone. Not sure if your doctor is up to it or not, but Adderall, and Vyvanse are very well tolerated stimulants. (I get bad panic attacks, and they don't increase them if you go with a low dose.)
> >
> > Any other questions, let me know!
> >
> > Best,
> > Jay
>
>
This is the end of the thread.
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