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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 Mike_Cohen_2 on June 24, 2008, at 16:56:03
As I've stated in recent posts, my anxiety has been my big problem since my brother past away 15 mos. ago.
I was on Serzone prior to his death for periodic Panic Attacks, but no generalized anxiety. Had trouble getting on an SSRI as I started getting crazy anxiety and the Serzone wasn't cutting it even at high doses. Had trouble combining Serzone with SSRI, so several mos. passed before I was able to get on Lexapro. My doc. took me up to 30mg over a few weeks, but anxiety persisted, then we made the switch to Zoloft 100mg. She tinkered with mood stabilizers and other augmenting agents, but nothing helped the anxiety. Recently, I said to myself, "I think these meds make me feel worse". I think I'm gonna try and get off everything but the benzos as they seem to work the best. The last drug I stopped was the Lamictal as it didn't do anything for me. It was only given for suspected BP II, I still don't know about that one.
So here is the deal. I cut my Zoloft to 75mg today from 100mg, and I feel a great reduction in my anxiety. It's still there, but I'd say it's about 30% better today, which is huge for me. My head is clear, I actually laughed with my kids today and was able to focus on them and no so much myself. You guys don't know me, but for the past 15 mos. I've been so caught up in this crap and constantly asking myself how I'm feeling all day long, checking my pulse, etc.
So, I ask this question and if the answer is yes, can I get some supportive reasons why too high of a dose of an SSRI can make anxiety worse ?
All along, my pdoc has been saying more is better for me due to my symptoms, but I'm just going off of my experience today which would seem to dismiss her statement. Thanks in advance as always.........
Gary
Posted by linkadge on June 24, 2008, at 17:13:44
In reply to Can High SSRI doses cause Long Term Anxiety ?, posted by Mike_Cohen_2 on June 24, 2008, at 16:56:03
One possable explaination is that you have the SS varient of the serotonin transporter gene.
Different individuals have different varients of the serotonin transporter gene. The SS varient already has a low baseline reuptake of serotonin, the LL varient has a higher baseline reuptake.
The idea that serotonin is the calming chemical is only partially true. It depends on the brain region involved. Elevated levels of serotonin in the amygdala, for instance, are highly anxiogenic.
A few studies have shown that individuals with the SS varient do not respond to SSRI medications very well. They respond with more anxiety, insomnia, start up reactions etc. etc.
This is just one possability. SSRI medications do not work for everybody and the increase in anxiety with SSRI's is not all that uncommon.
Linkadge
Posted by Mike_Cohen_2 on June 24, 2008, at 17:25:35
In reply to Re: Can High SSRI doses cause Long Term Anxiety ?, posted by linkadge on June 24, 2008, at 17:13:44
Linkage, so if you don't have the SS varient, do you get the reverse effect with an SSRI i.e, depression, anxiety ?. If no reverse effect and the SSRI's won't work for ya, than what are your other options.
Thanks in advance....
Gary
Posted by Racer on June 24, 2008, at 18:24:13
In reply to Can High SSRI doses cause Long Term Anxiety ?, posted by Mike_Cohen_2 on June 24, 2008, at 16:56:03
First of all, not all SSRIs were created equal. Zoloft and Prozac are known as the more activating SSRIs, so you may have better results from one of the others -- Paxil and Lexapro are often considered more anxiolytic. You may find that Celexa is more helpful for you than Lexapro was.
Also, very often the anxiety is a transient response to an anti-depressant. It might be that waiting it out is worth it -- and I do mean waiting it out at a full therapeutic dose. I know it's hard, especially since what you've described here -- both in this post and in others -- sounds rather obsessive/compulsive, which makes it harder to judge effectiveness.
For instance, taking your pulse frequently is probably counter productive. The more you can find ways NOT to think about every somatic effect you have in the first two months or so, the better able you'll be to find an effective medication for you.
I don't think you've ever answered the questions about grief counseling -- it's far more difficult than medications, but I think you might have more lasting benefit from it.
As far as medications go, it is probably worth trying BuSpar, Seroquel, Lamictal, Cymbalta, or Remeron. The BuSpar worked best for me, but a lot of people say it hasn't had any effect on them. Personally, I wonder if they're looking for an immediate, noticeable effect, such as you get from benzos. BuSpar certainly didn't offer that for me -- I just found that, after a couple of weeks, I was feeling much calmer and stronger.
Good luck.
Posted by cumulative on June 24, 2008, at 18:47:56
In reply to Re: Can High SSRI doses cause Long Term Anxiety ? » Mike_Cohen_2, posted by Racer on June 24, 2008, at 18:24:13
Pro-tip: Bupropion is just as anxiolytic in studies as SSRIs. Personally, it makes me far less nervous -- especially socially -- than any SSRI, although many people react with anxiety.
Posted by johnj on June 24, 2008, at 19:21:33
In reply to Re: Can High SSRI doses cause Long Term Anxiety ? » Mike_Cohen_2, posted by Racer on June 24, 2008, at 18:24:13
Racer:
Did you have any feelings of depression on buspar? It may be one for me to try. Thank you.
Posted by Phillipa on June 24, 2008, at 20:12:13
In reply to Re: Can High SSRI doses cause Long Term Anxiety ? » Racer, posted by johnj on June 24, 2008, at 19:21:33
High doses of ssri's cause higher anxiety in me and my pdoc no longer starts patients on high doses tiny ones and build up. Phillipa
Posted by johnj on June 24, 2008, at 20:30:40
In reply to Re: Can High SSRI doses cause Long Term Anxiety ?, posted by linkadge on June 24, 2008, at 17:13:44
Wow, you have some great info Linkadge. I think someone with the SS variant may give the impression of being bipolar too. This gives rise to the medication merry go round. Too bad they don't test a person or can they?
If someone has the SS variant what do they do? TCA's?
regards
johnj
Posted by Racer on June 24, 2008, at 21:23:36
In reply to Re: Can High SSRI doses cause Long Term Anxiety ? » Racer, posted by johnj on June 24, 2008, at 19:21:33
> Racer:
>
> Did you have any feelings of depression on buspar? It may be one for me to try. Thank you.That's a very difficult question to answer. The short answer is, "I don't think so..."
The longer version is that I was suffering an episode of major depression at the time I was taking it, the depression is badly controlled by medication at the best of times, and the medications I was taking all added up to something which led to dissatisfaction. Thus, stopping the BuSpar.
It's on my list to try again, though. When I was taking it before, I was also taking Cymbalta, and I think Lamictal -- though I'm not sure about the last. Lamictal caused increased depression for me, but I don't think there was any overlap in time. My reaction to SRIs is usually apathy, dissatisfaction with myself, intense self-criticism for not being more productive, etc. The apathy and amotivation were pretty intense -- but the doctor attributed it to the BuSpar, not the Cymbalta.
BuSpar is the only anxiolytic which has ever been both effective and tolerable for me. I would like to try it again, now that I'm on more activating medications, and have spoken to my doctor about it. He's amenable, so it's on our list. There's another drug ahead of it, so I'll try that and see how it goes.
I hope either the long or the short answer helped. Good luck to you.
Posted by blueboy on June 25, 2008, at 13:51:16
In reply to Can High SSRI doses cause Long Term Anxiety ?, posted by Mike_Cohen_2 on June 24, 2008, at 16:56:03
My answer would be "yes". I don't pretend to have any great theoretical knowledge, but I simply cannot take an SSRI.
My problem has been (recently) diagnosed as Bipolar II, though. I don't know whether my reaction would be better characterized as anxiety or "manic stupor", but whatever it was -- well, just for example, Prozac put me in a condition where all I could do is sit and stare. I felt frozen with fear -- I could barely talk, much less look at someone.
So, in some cases (me, LOL) SSRI's can cause terrible reactions. They might or might not be correctly described as "anxiety" (although I have serious doubts as to whether the DSMIV has much of a grasp on the subject), but are characterized by an inability to do certain tasks combined with a strong and unrealistic feeling of fearful apprehension.
Wellbutrin and Effexor also caused extremely serious problems at higher dosages. I don't think I've taken an SSRI/SSNI at high dosage since Effexor put me into seizure.
Posted by linkadge on June 25, 2008, at 20:07:39
In reply to High SSRI doses cause Long Term Anxiety ? LINKAGE, posted by Mike_Cohen_2 on June 24, 2008, at 17:25:35
There really aren't a whole lot of options. Most antidepressants doctors are comfortable prescribing affect the serotonin transporter.
Individuals with the SS varient tend not to gain much benefit from serotonin uptake inhibitors (probably cause their serotonin transporters are alreadly low). Its a lot more complex than this though so I take this research with a grain of salt.
Different SSRI's can sometimes affect people differently.
You could try wellbutirn, but its not great for anxiety. Some doctors will prescribe benzodiazapines or anticonvulsants for anxiety.
I guess the bottom line is that if SSRI's make things worse don't blame yourself. Unfortunately psychiatry is not at the point where it can adequately help everbody.
Linkadge
Posted by linkadge on June 25, 2008, at 20:10:31
In reply to Re: Can High SSRI doses cause Long Term Anxiety ?, posted by blueboy on June 25, 2008, at 13:51:16
Sometimes people adjust to the "start up" anxiety with SSRI's. Somtimes SSRI's are simply not effective for all forms of generalized anxiety. I know of a few people that took SSRI's for > 6 months and still felt jittery on them.
Linkadge
Posted by chiron on June 26, 2008, at 20:44:02
In reply to Re: Can High SSRI doses cause Long Term Anxiety ? » Mike_Cohen_2, posted by Racer on June 24, 2008, at 18:24:13
Interesting. I just increased my Celexa from 30 to 40 (mostly to help w/ anxiety), and I have been waking up "activated". If it doesn't go away, I will go back down.
This is the end of the thread.
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