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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 Joe Schmoe on November 7, 2010, at 7:00:48
I suffer from social anxiety and dysthymia/atypical depression (eat/sleep too much). I have often had suicidal thoughts, but not the "can't get out of bed" type depression.
Over the years I have controlled both of these conditions fairly well with clonazepam and citalopram. The clonazepam I have varied in dosage from .5 to 2 mg a day depending on the circumstances. Since returning to school I have greatly cut down the dosage and kept it at .5 mg or less pretty consistently until recently.
The citalopram I have mixed feelings about. I hate the way it makes me gain weight and lose sexual sensation/drive, things which are inherently depressing. On the other hand, when I go off it (which I have several times) I eventually sink into a black depression when things in my daily life turn sour and I find myself with nothing to look forward to. I end up going back on it, and my outlook tends to improve.
Occasionally I try to go off citalopram and replace it with Wellbutrin (or take both at once). In the past this has resulted in chest pains and, eventually, anxiety while sitting home alone at night, out of the blue, with no social situation involved. I always end up having to go off it even though for a while it really brightens my mood.
Recently I decided to try again. I weaned off citalopram (always a nightmare) and was going to try the selegine patch Emsam. However after finding out the price, and the fact most people have to take it at a dose which brings with it the "cheese effect", I decided against it and decided to try Wellbutrin again. This time, unlike the past with the SR formula, I would be using the 24 hour Wellbutrin XL at 150mg. I hoped the gradual release and low dose would help me avoid chest pains, which it did. Unfortunately it caused me to feel extreme irritation and often rage, punctuated by anxiety and sometimes hopelessness. Not the result I was looking for.
I should add that my life circumstances recently of returning to school to try to start a new career, deal with difficulties at school (the program seems disorganized and I am not sure it is preparing me well for job market), researching the job market (nothing makes me anxious and depressed like reading job ads for which I don't qualify), and this awful recession are combining to make me upset and worried most of the time.
I recall Wellbutrin being much better for mood in the past. This time around maybe I just have too many negative things on my mind, but it is not making me happy, it just makes me angry/anxious and often, I feel extremely depressed. In any event I gave up on it and asked the doctor for a much lower dose, which meant the regular, non-time-release formula, which I then cut down to 37.5 mg doses. I figured at this dose, which isn't even on the therapeutic scale, I might get some benefit from it - I seem to be very sensitive to it, and wanted to try very low and medium doses to see what happened.
If anything the anxiety and depression have gotten much worse. I even quit the wellbutrin a few days ago but it doesn't seem to have made much difference. What is really taking me by surprise is that I increased the clonazepam to the full 2 mg awhile ago as the stress level at school increased and I began worrying more about what was going to happen after graduation. Even at 2 mg the clonazepam isn't making a dent in this at-home, non-social anxiety. I have never experienced anything like this before. Normally if just on clonazepam I would never suffer anxiety just sitting at home - it always took a large dose of wellbutrin to cause that kind of anxiety outside of a social situation.
Now I am wondering if I need to go back on the citalopram, much as I hate the thought. That article a few months ago about ssri's being no better than placebo didn't make me any fonder of it, but I do think it helps me avoid the blackest pits of depression.
I have always taken clonazepam for social anxiety, not general anxiety, usually in combination with citalopram for depression. But shouldn't the clonazepam be helping with this anxiety about the future? 2 mg used to knock me out. Now it doesn't even make a dent in my wakefulness level, never mind this terrible anxiety that keeps washing over me. I have been taking it since 2001 or so, varying the dosage as needed. I have never needed to go over 2 mg. It seems unlikely I have suddenly acquired a tolerance to it.
Is there such a thing as a dud batch of clonazepam? Could it have been exposed to heat or something during delivery to the drugstore? It seems incredible that it is not helping at all with the anxiety at this dosage.
I just hope the citalopram will help with this anxious feeling if I start taking it again. It is a classic "tightness in the chest" feeling - not the chest pains Wellbutrin caused, but the kind of normal anxious feeling you get before a job interview, test, etc. but much stronger. Maybe citalopram has helped me control it in the past and I didn't realize it. I never thought of it as particularly effective for anxiety, but that may be colored by my particular flavor (social anxiety).
I also wonder if I should ask my doctor to prescribe brand name Klonopin. Anybody know how expensive that is in the U.S. compared to the generic stuff? I have no idea. Currently taking Mylan generic.
Posted by Maxime on November 7, 2010, at 23:59:29
In reply to A tsunami of anxiety - bad batch of clonazepam?, posted by Joe Schmoe on November 7, 2010, at 7:00:48
You could ask to try a different generic and see what happens.
Another poster here had chest pain on Wellbutrin. Here is her thread http://www.dr-bob.org/babble/20101030/msgs/968367.html
Posted by Joe Schmoe on November 15, 2010, at 10:06:13
In reply to Re: A tsunami of anxiety - bad batch of clonazepam? » Joe Schmoe, posted by Maxime on November 7, 2010, at 23:59:29
Well the anxiety and depression got so bad I decided to go back on Celexa.
Within 24 hours the difference was amazing. My roommate described me as 80% better. I am not thinking about suicide all the time anymore.
I know ssri's are supposed to take weeks to work, but whatever was going on, something was way out of whack and the citalopram definitely lifted me out of that hole almost instantly. Strange. I have been on and off it before a number of times and never had such a dramatic quick impact before, that I remember anyway. Maybe I have some kind of post-ssri situation going on. I have noticed in the past that after I go off it, I sink into a black hole of depression after a number of months, after the withdrawal symptoms (brain shocks, etc) have worn off. This time I weaned off it in July, which is about 4 months ago.
I still have some anxiety when I first wake up and lie there thinking about stressors in my life, and I have some initial edginess from the first few weeks of the ssri. The clonazepam is helping with that I'm sure since it is not bad. (The clonazepam had no effect on the massive anxiety I was having a week ago.) But at least I can sleep now, and for a full 8 hours too. (I've been back on it about a week, first few nights were only six hours' sleep and "pop wide awake" initial ssri type stuff).
I am continuing to take 37.5 mg of wellbutrin (immediate release 75 mg, cut in half) to see if it will help with the sexual numbing that goes with Celexa. Once the celexa settles in and the initial anxiety from it reduces, I may try slowly increasing the wellbutrin dose. I know I can't tolerate 150mg a day of it due to eventual anxiety and chest pains. I am hoping much lower doses than are normally prescribed will still help since I seem to be very sensitive to it.
So right now
20 mg citalopram
2 mg clonazepam
37.5 mg bupropion
Posted by Joe Schmoe on November 16, 2010, at 10:37:09
In reply to Celexa to the rescue, posted by Joe Schmoe on November 15, 2010, at 10:06:13
I should also note that I switched from my Mylan clonazepams to some older Sandoz ones I had laying around for a few days.
Now that I switched back, I am starting to feel anxious again. I have searched online and found one too many people talking about how bad the quality of Mylan clonazepams is, and am going to switch pharmacies to get Teva instead.
Posted by Joe Schmoe on November 23, 2010, at 10:23:45
In reply to Re: Mylan clonazepam - hmmm...., posted by Joe Schmoe on November 16, 2010, at 10:37:09
Boy, the anxiety is not getting any better. I thought if it was initial ssri anxiety it would be better after 16 days on 20mg of the citalopram, but it isn't. The clonazepam helps somewhat for awhile after I take it, but not that much and not all the time.
I really hope this passes, I don't recall experiencing this kind of at-home anxiety before on just citalopram and clonazepam. (My anxiety is primarily social.) Not sure what I will do if it doesn't improve. I have never gone over 2 mg of clonazepam before, in the 8 or 9 years I have been on it, in fact usually I take less than 2 mg a day to avoid sedation, but then again I was always taking it for social anxiety. It seems unlikely after 9 years that I have suddenly developed a tolerance to it.
This constant anxiety when alone is something new. I am sure it is linked to my fears about getting a job after graduation next year.
This is the end of the thread.
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