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Re: ssri's and anxiety » johnj

Posted by Tony P on February 9, 2008, at 3:18:17

In reply to Re: ssri's and anxiety » Tony P, posted by johnj on February 7, 2008, at 20:18:28

> Tony:
>
> Thank you for your replies it is what I really needed. I have been thinking of doxepin or trimipramine for sleep. Have you ever tried doxepin? I wish I could over sleep! I have tried two doses of 100 mg of neurontin and it is not making me feel very well, acutally more down. Another med bites the dust!
>
> I was on remeron for 3 years and although it helped me sleep I couldn't shake the stomach tension and chest tension it would cause. I just put up with it. It was very hard to come off of. I tried it a second time out of desperation and I did even worse the second time. I believe it really made my ocd worse and made me a big *ss too. The remeron rage was scary.
>
> Do you have any ocd with your anxiety? How did you titrate up on lexapro. I might have to do that. Do you take the requip because of lexapro causing jitterness? Thanks
>
> johnj


I tried doxepin many years ago and although it is said to be similar to trimipramine I found it frighteningly powerful -- much stronger than say, Elavil, and much, much stronger as an A/D than trimipramine -- although that may have just been where I was at at the time, or my own idiosyncrasy to it. I spent about a week unable to get out of bed because I was so sleepy 24/7, felt somewhat normal/good for about two days, then started to climb the wall with anxiety for the next week. And I was scared to stop taking it, since the sedating effect helped temporarily with the anxiety! In the end I tapered off over a few days. But YMMV, as usual, and many people have used it successfully. I was taking 25 mg t.i.d., a pretty normal starting dose; however, if you're sensitive to the stimulating component of TCA's, as I am, I'd start with just 25 mg at bedtime, none during the day (subject of course to your pdoc's advice), and see how you do.

I tried neurontin, just for sleep, taking 2 - 300 mg caps at bedtime. Oddly, although it made me so dopey I had trouble filling out my schedule for the next day half an hour later, it didn't help me _get_ to sleep - I still tossed and turned for an hour or more (my GP nodded and said m-hm when I described this, so my experience apparently is not unusual). But it did _keep_ me asleep -- it stopped me from waking wide-eyed at 4 AM as I had been doing. At that dose, I got a bit of a hangover next morning -- not unpleasant, after a shower and cup or two of coffee I felt quite high and turned into a chatterbox, unusual for me in the morning! I suspect you did not take enough to be effective, the therapeutic range is quite wide, at least 300 to 1800 mg per day, depending how it's used and what for. I took up to 1800 mg/day a few times when I was having pain from a pinched nerve and it helped that quite a lot.

The tension you describe from Remeron - was it just immediately after you took it, or did it develop gradually? The first time I tried it, I had terrible akathisia - I couldn't stay awake & I couldn't sleep for more than a minute without jerking or jumping up. This time around I've been taking it with Requip (.75 mg) and have had no trouble with akathisia at all unless I mix it with other things which can also cause akathisia (e.g. trazadone, seroquel). If the tension you're experiencing is constant, I guess it means it's just too activating for you. I'm taking 2 mg clonazepam most days which no doubt mellows me out a bit!

I don't find the Requip has much effect if any on anxiety or daytime jitteriness; it made me a bit sleepy at first at .75 mg or more (be very cautious if you take it in the daytime until you know how you react - a few people have fallen asleep at the wheel without feeling any warning!), but that passed after a few months. I take it more to avoid the akathisia side-effect, and also as a dopamine mood-enhancer because a small pilot study (Can J. Psych) a couple of years ago showed people taking a wide variety of A/Ds and mood stabilizers showed improvement when Requip was added, no matter what their primary med was. I don't actually _feel_ anything from it directly, but I do believe my mood is better with it than without it. It might help you with the Remeron side-effects around the clock if you divide your dose -- e.g. .5 mg 3x a day, or more if you need it -- it also has a wide therapeutic range, and my 1.5 mg/day total is at the low end.

On the other hand, have you tried Buspar? The tension & rage you describe are something I found Buspar very helpful with years ago - I haven't tried Buspar with Remeron, but I suspect it might make a good combination. Not everybody seems to respond to Buspar, again there's a wide dosage range, from 10 to 60 mg / day -- I usually took 20mg, 10 on a good day, when I was on Serzone.

I definitely have some OCD, not really classic compulsive washing and counting and so on, but I will eat, read &/or or play computer games compulsively -- e.g. I can't stop reading to do anything and as soon as I finish one book I have to pick up another. If I don't retreat into reading I ruminate with lots of negative thoughts and rehearsing imaginary conversations, which again is not quite classic obsession, but close enough for me, and very unpleasant.

I didn't titrate up on the lexapro at all -- just started in at 10 mg every morning for a few months, then upped it to 20 when my depression got worse again. And no trouble stopping it -- I tapered off over about 3 days, but I think I could probably have stopped cold. Not at all like Effexor! I'm not taking it now but I might consider going back to it if my new pdoc wants to push it.

A long answer to your short questions! Good luck,

Tony


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poster:Tony P thread:811306
URL: http://www.dr-bob.org/babble/20080207/msgs/811663.html