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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by dannen on October 21, 2003, at 21:32:22
I have been diagnosed with agitated depression. I have very bad anxiety in the morning. I wake up at about 5 am, with waves of anxiety. The anxiety is bad until about 8 am, and then it gets better through the morning and usually is gone by noon. Nights are fine. Then the cycle begins all over again.
Does anyone else have this? What medication has helped? Nothing has worked for me yet. (Prozac, Zoloft, Paxil, Lexapro all caused great agitation.) Help.
Dannen
Posted by McPac on October 22, 2003, at 0:02:44
In reply to Agitated depression; anxiety bad in morning, posted by dannen on October 21, 2003, at 21:32:22
"Prozac, Zoloft, Paxil, Lexapro all caused great agitation"
>>>>>>>>>> Did those meds CAUSE extreme anger in you?
Posted by dannen on October 22, 2003, at 0:58:14
In reply to Re: Agitated depression; anxiety bad in morning, posted by McPac on October 22, 2003, at 0:02:44
Those meds made me feel like I was shaking out of my skin. Remeron put me to sleep at night, but then caused similar agitation the next day. I am looking for an AD that I can tolerate to help with the morning anxiety. I am curious if anybody else has experienced this kind of agitated depression and what worked to relieve it. Thanks for the interest. Dannen
Posted by jrbecker on October 22, 2003, at 1:27:29
In reply to Agitated depression; anxiety bad in morning, posted by dannen on October 21, 2003, at 21:32:22
sounds like you're a typical melancholic-type depressive. even though I am an atypical depressive -- who's best sleeping hours are usually early morning -- I do sometimes exhibit early morning awakenings. I attribute this as partly due to the "condition" and partly the meds themselves (most ADs cause some sort of circadian phase shift). In terms of the SSRIs/SNRIs, I found that in the long-term run, effexor was really good at keeping me asleep through the night. However, you have to wait at least 1-2 months before your sleep is stabilized. There is definitely an adjustment period to these side effects, but once you're over that hump, sleep normalizes. Second to that was celexa - which did cause some early morning awakening issues once and a while, but not as bad as my trials with zoloft, prozac or lexapro.
I don't know if you're considering Serzone as an option, but it will definitely solve your early morning awakening problem. Of course, it comes with other tradeoffs.
What experience do you have with benzo's? A very low dose of Klonopin or Xanax XR, in combo with Ambien gets me an extremely efficient night's rest with no grogginess the next day. You might want to explore this strategy with your doc.
> I have been diagnosed with agitated depression. I have very bad anxiety in the morning. I wake up at about 5 am, with waves of anxiety. The anxiety is bad until about 8 am, and then it gets better through the morning and usually is gone by noon. Nights are fine. Then the cycle begins all over again.
>
> Does anyone else have this? What medication has helped? Nothing has worked for me yet. (Prozac, Zoloft, Paxil, Lexapro all caused great agitation.) Help.
>
> Dannen
Posted by zeugma on October 22, 2003, at 9:33:37
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by jrbecker on October 22, 2003, at 1:27:29
Jrbecker is right, it sounds like classic melancholic depression. Effexor is a good treatment for this, but TCA's have long been considered the best treatment for this condition. Most of them are fairly sedating, unlike Effexor, and you can take them at night and they gradually begin to regulate your sleep. Also the seronin effect of the newer drugs is more pronounced, which can also worsen the agitation in the beginning of treatment.
Posted by dannen on October 22, 2003, at 13:39:44
In reply to Re: Agitated depression; anxiety bad in morning » jrbecker, posted by zeugma on October 22, 2003, at 9:33:37
Jrbecker & Zeugma: Thanks so very much for your caring and advice.
I agree that it sounds like a classic melancholic depression re bad in the morning, better at night. But could my agitated depression be a mixed state form of bi-polar? I had thought that might be a reason I could not tolerate Prozac, Zoloft, Lexapro, or Paxil. (Wellbutrin was even worse. Lamictal also was too "activating"). Could my intolerance suggest BPII, where the agitation is hypomania? Just a thought. This whole "mixed state" thing is confusing/deceiving. I had some acupuncture the last few weeks; it killed the anxiety completely, but then the depression was terrible. So, it makes me think the anxiety is really the way the depression is manifesting itself, if that make sense.
I have thought about Effexor XR and a TCA, perhaps nortriptyline. Any advice on the TCA? I had heard the nortriptyline has a narrow therapeutic window, and I fear my psychiatrist is too unfamiliar with TCAs to be a reliable guide. It seems that since the SSRIs came out in the late 1980s, psychiatrists has lost touch with the TCAs--at least where I live.
My psychiatrist appears to feel most comfortable with Effexor XR and Lexapro. He mentioned titrating up on the Effexor XR very slowly--opening the capsule and taking only a few particles at a time. (Apparently, this was discussed at a recent seminar.) I want to avoid the benzos. I tried Xanax for about a month, and when I came off it the anxiety was absolutely horrendous.
Any further advice would be greatly appreciated. I have fought this anxiety without meds for over eight months, and I need some medical invention. I tried Neurontin for several months last year, but it caused a real brain fog and muscle jerks for large muscles (legs, stomach) and tics for smaller ones.
Again, thanks so very much. Dannen
Posted by zeugma on October 22, 2003, at 20:23:49
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 22, 2003, at 13:39:44
> Jrbecker & Zeugma: Thanks so very much for your caring and advice.
>
> I agree that it sounds like a classic melancholic depression re bad in the morning, better at night. But could my agitated depression be a mixed state form of bi-polar? I had thought that might be a reason I could not tolerate Prozac, Zoloft, Lexapro, or Paxil. (Wellbutrin was even worse. Lamictal also was too "activating"). Could my intolerance suggest BPII, where the agitation is hypomania? Just a thought. This whole "mixed state" thing is confusing/deceiving. I had some acupuncture the last few weeks; it killed the anxiety completely, but then the depression was terrible. So, it makes me think the anxiety is really the way the depression is manifesting itself, if that make sense.
>FRom what I know, BPII would be on the "mood-reactive" side of depression. Agitated depression in itself is more or less what I experience; very anxious, pacing, restless (but fatigued) and insomnia. Terrible mornings, evening slight recovery (melancholic depresssion). I have relatively low mood reactivity, but lots of anxiety.
> I have thought about Effexor XR and a TCA, perhaps nortriptyline. Any advice on the TCA? I had heard the nortriptyline has a narrow therapeutic window, and I fear my psychiatrist is too unfamiliar with TCAs to be a reliable guide. It seems that since the SSRIs came out in the late 1980s, psychiatrists has lost touch with the TCAs--at least where I live.
Psychiatrists have completely lost touch with TCA's! Last year I walked into a pdoc's office and was determined to get a TCA at all costs as the only period of near-remission in my life was after I'd spent a year on nortriptyline in my early twenties. Lots of other treatments after that, lots of disasters. Luckily my pdoc knew what TCA's could do because he is an ADD specialist (another of my many diagnoses). Nortriptyline has gotten me out of a truly terrible place, and really has no more side effects than SSRI's or Effexor. The new drugs were always compared with the tertiary amine tricyclics like amitriptyline as the basis for their suopposedly superior side effect profiles. Somehow all TCA's got lumped in with them as drugs with terrible S/E profiles. Meanwhile the newer drugs cause more sexual dysfunction than any TCA and often this side effect doesn't go away, while tolerance develops to most of the TCA side effects.
>
> My psychiatrist appears to feel most comfortable with Effexor XR and Lexapro. He mentioned titrating up on the Effexor XR very slowly--opening the capsule and taking only a few particles at a time. (Apparently, this was discussed at a recent seminar.) I want to avoid the benzos. I tried Xanax for about a month, and when I came off it the anxiety was absolutely horrendous.I have been considering a benzo for the past few months. I don't know if my pdoc would prescribe it. I will ask him about the pluses and minuses because I do have bad anxiety sometimes, but I also don't want to add another med, and also I'm crossing my fingers that the last week has been truly indicative of progress and the anxiety IS dissipating.
Nortriptlyine is an extremely effective med for melancholia. This is one of the best-documented facts in psychopharmacology. It has a relatively narrow therapeutic window but the upside is that your pdoc can use it to determine whether the problem is dose-related or just that you're not having the desired response to the med and it might be wiser to drop it. That's a big advantage if you ask me.
>
> Any further advice would be greatly appreciated. I have fought this anxiety without meds for over eight months, and I need some medical invention. I tried Neurontin for several months last year, but it caused a real brain fog and muscle jerks for large muscles (legs, stomach) and tics for smaller ones.
>
> Again, thanks so very much. Dannen
Posted by dannen on October 22, 2003, at 20:41:07
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by zeugma on October 22, 2003, at 20:23:49
Zeugma. Thank you so very much for the information. I will research nortriptyline and discuss it with my doctor tomorrow. Can I take it in one dose at night, or is it too activating? Dannen
Posted by Viridis on October 23, 2003, at 2:00:10
In reply to Agitated depression; anxiety bad in morning, posted by dannen on October 21, 2003, at 21:32:22
That's a pretty common pattern, and I've been there many times (bad mornings, improvement through the day). If you possibly can, I'd try to get the anxiety under control with a benzo -- Klonopin was best for me (Xanax is good too, but doesn't last as long, is harder to get prescribed, and may cause more tolerance issues).
For me, managing the anxiety was essential to further treatment. I can't tolerate SSRIs (Prozac, Zoloft, etc.) and Wellbutrin is even worse. Strattera (which I take for ADD) actually seems helpful as an antidepressant without the anxiety, and might be worth a try. But for the short term, at least, a benzo seems the logical treatment and might make the transition to an appropriate AD much easier, especially given the time it takes most ADs to induce a response.
The agitation you're experiencing is not healthy for your mind or your body, and if your doctor won't prescribe something that provides rapid relief, I'd look for another doctor.
Posted by zeugma on October 23, 2003, at 5:11:51
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 22, 2003, at 20:41:07
> Zeugma. Thank you so very much for the information. I will research nortriptyline and discuss it with my doctor tomorrow. Can I take it in one dose at night, or is it too activating? Dannen
I take nortriptyline in one dose at night, 75 mg. I find it more sedating than activating.
Posted by dannen on October 23, 2003, at 13:17:26
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by Viridis on October 23, 2003, at 2:00:10
Thanks for the information, Viridis. I tried Xanax in August 2002 for a month. It worked very well initially. I was euphoric. But it worked less and less as the weeks went by, even on larger doses. I then stopped taking it, and the anxiety was ten times as bad. I could not tolerate any of the SSRIs. I never tried Strattera (spelling?). I thought it was supposed to be stimulating. Hmm. Does it work for agitated depression? How is it different from an SSRI? Did you ever find any anti-depressant that worked? Every day I swim, meditate, and do yoga. I get massage once a week and do gigong once a week. The morning anxiety still is hardly manageable. This has been going on for over one year, and I realize I need something to deal with my brain chemistry.
Thanks for caring. Dannnen
Posted by dannen on October 23, 2003, at 13:23:10
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by zeugma on October 23, 2003, at 5:11:51
Zeugma. Thanks. Do you have to have your blood checked to determine if 75 mg. is at the theurapeutic level? My psychiatrist seems unfamiliar with TCAs, and that might be an obstacle to him prescribing a TCA. I have read the TCAs are better for melancholic depression, especially in men over 40 (nortriptyline). I hope I can get it and then tolerate it. I also am thinking about gabitril for sleep or doxepin for sleep. But I think I probably need more than help with my sleep. Have you ever tried St. John's Wort (SJW)? I only bring it up because I have such a hard time tolerating any medicine, and SJW apparently is relatively easy to tolerate.
THANKS AGAIN FOR YOUR KINDNESS. Dannen
Posted by Viridis on October 23, 2003, at 14:05:12
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 23, 2003, at 13:17:26
Hi Dannen,
Xanax seems to be one of the worst benzos for building tolerance -- I've had that experience too, so now just use it occasionally. Klonopin (clonazepam) seems to be quite different; I've been on the same dose for a long time, and my pdoc has lots of other patients who have been on the same dose for many years. He's very cautious with Xanax, and based on his experience much prefers to prescribe Klonopin. It's very subtle, but really works for anxiety. It also has mood-stabilizing effects for some people (like me). Of course, you are likely to become dependent on it, as you would with most antidepressants, so need to discontinue it gradually if you decide to stop using it.
Strattera isn't stimulating for me, but I do take it (and Adderall, an amphetamine) primarily for ADD, so I could be a special case. With Strattera, I'd definitely recommend starting with a low dose (say, 25 mg) and working up gradually. So often, the doctors want you to try a full dose of these meds right from the start, and the side effects from many can be intolerable that way. I always like to start low and go slow. Having an anti-anxiety med like Klonopin in place first can help the transition greatly.
I haven't tried tricyclics, but know several people who have really benefitted from them. I'm not aware of any evidence that the newer ADs are any better (on average) than the older tricyclics that are now off-patent (and so not heavily marketed).
Good luck!
Posted by zeugma on October 23, 2003, at 18:44:48
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 23, 2003, at 13:23:10
Hi Dannen,
As Viridis says it seems that tolerance develops less with Klonopin than with Xanax. Right now I feel I could use some Klonopin... i am prone to anxiety-induced freakouts that result from extreme inhibition and self-consciousness. I may have to tell my pdoc (see him tommorow)my latest story...I also take Strattera and it is a good med, it treats my inattentive ADD symptoms and is a fairly tolerable drug. Similar to nortriptyline in terms of side effects (dry mouth and constipation, dry skin, dry hair etc.).
About nortriptyline dosage: I was on 60 mg when my pdoc ordered blood levels. I was still experiencing ADD symptoms (TCA's also help ADD a little). I was just under the window, maybe 45ng/mL. I raised it to 75 mg which puts me just inside the 58-148 ng/mL window. Nothing comparable exists for any of the newer AD's. The advantage is that it reliably correlates with response, so you can adjust the dosage rationally rather than by guesswork, and the window is well documented, so your pdoc can just consult a standard reference work to determine where your blood levels fall.
Posted by dannen on October 23, 2003, at 18:51:39
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by zeugma on October 23, 2003, at 18:44:48
Zeugma. THANKS.
I will be meeting with my pdoc in about an hour, and I will suggest nortriptyline. I hope I can tolerate it. I have been unable to tolerate anything so far (the SSRIs [agitation], Remeron [fast pulse], Wellbutrin [great agitation], Lamictal [agitation]). But I have never tried a TCA. I hope TCAs are different.I really appreciate the information and your kindness. God bless you.
Dannen
Posted by zeugma on October 23, 2003, at 20:19:52
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 23, 2003, at 18:51:39
> Zeugma. THANKS.
> I will be meeting with my pdoc in about an hour, and I will suggest nortriptyline. I hope I can tolerate it. I have been unable to tolerate anything so far (the SSRIs [agitation], Remeron [fast pulse], Wellbutrin [great agitation], Lamictal [agitation]). But I have never tried a TCA. I hope TCAs are different.
>
> I really appreciate the information and your kindness. God bless you.
Dannen,You're very welcome. Let us know what your pdoc says. I hope he is able to help you.
z
>
> Dannen
Posted by dannen on October 24, 2003, at 14:20:36
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by zeugma on October 23, 2003, at 20:19:52
Viridis and Zeugma. Pdoc prescribed nortriptyline. It comes in a liquid form, which he had the pharmacy order. I am very sensitive to meds, so he wants me to titrate up slowly. He has several other patients who use it. He is older, so he prescribed TCAs before the SSRI era began in the late 1980s. That gave me some comfort. I asked about the therapeutic window (which I have seen variously as 30ng-150ml and 50ng-150ml), but he said that such range is not hard and fast, and that he has seen people respond on much lower doses. (He said has has some patients on Prozac at 1 and 2 mg.) He said that no blood tests would be required. Anyway, I'm going to start next week when the med comes in, and then see if I can tolerate it. He wants me to start at 1 mg and work up. That may sound silly, but I am SO sensitive to meds. When I used to drink alchohol, one beer used to make me drunk. One cup of coffee would make me high. So, he thinks that even 10 mg may be sufficient. That contradicts what I have read about Pamelor/Aventil online, and what you two suggest. I hope it works. Comments appreciated. Thanks. Dannen
Posted by Viridis on October 25, 2003, at 2:33:05
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 24, 2003, at 14:20:36
Hi Dannen,
It sounds like you have a very reasonable doctor who appreciates your medication sensitivity. Again, I have no experience with tricyclics (beyond what friends have told me), but my understanding is that they can be very effective. I will emphasize though that, if you have anxiety issues or weird stress reactions while you're adjusting to the new meds, benzos can be very helpful and you shouldn't be afraid to ask for them. I'd recommend clonazepam, although obviously your doctor knows you best.
Good luck!
Posted by dannen on October 26, 2003, at 19:04:55
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by Viridis on October 25, 2003, at 2:33:05
Viridis. Thanks again for the advice. I took a benzo for a month in August 2002--Xanax. It is horrible stuff. They won't even prescribe it at one hospital I visited last summer because of additive potential. Check the web. It can be dangerous. Klonopin apparenly is much milder. My sister-in-law is a pharmacist, and she has taken it for some time for sleep. I wouldn't know. Right now, I need to find a TCA I can tolerate that can reduce my agitated depression. I am told that nortriptyline may be the right choice. Wish me luck. Best to you. Dannen
Posted by Viridis on October 28, 2003, at 2:01:53
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 26, 2003, at 19:04:55
I've found Xanax very helpful, but I did build tolerance to it quite suddenly and now have to take much more to achieve the same effect than I did initially. Since I've always used it just as an occasional adjunct to Klonopin, this really hasn't caused me any problems. However, its short half-life, combined with the potential for tolerance and thus the need for higher doses, can cause problems for some people, especially those who use it regularly. My pdoc is quite willing to prescribe a set (fairly small) amount every three months, but also says that if my frequency of use increases, that's a cause for concern. Fortunately, I haven't had any desire to use it more often (once every week or two, on average). He doesn't seem nearly as comfortable with it as with Klonopin.
Klonopin is powerful stuff too, but I find it much more subtle, and most people seem to be able to get anxiety relief with the same dose for long periods of time. That's been my experience, and my pdoc says the same thing is true for many of his patients. However, like all benzos (and most antidepressants), if you decide to quit it, you need to do so gradually. Klonopin's gentle effects and long half-life may make it seem milder than Xanax, but it's a very potent med. However, so are most of these psychiatric drugs. They all change your brain chemistry, after all (which is what they're supposed to do, for the better) and if you've been using any of these meds for long it's best to discontinue slowly.
Posted by dannen on October 28, 2003, at 12:37:49
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by Viridis on October 28, 2003, at 2:01:53
Viridis or Zeugma. Have either of you experience with having blood plasma levels checked after taking nortriptyline? At what point is this done? I read that one should have this done after being at 75 mg for 7 days. Any guidance.
Viridis. Thanks for the information on Xanax and Klonopin. Can one take Klonopin every day, without the risk of needing more (i.e., developing a tolerance)? My sister-in-law takes it 5 days on, 2 days off I think. I knew a priest who got up to 20 mg a day. (Yes, that amount seems impossible, but it is true. He was detoxed at a hospital over several months. A very kindhearted man who get horrible advice from his doctor.)
I need an antidepressant that works for anxiety. My morning anxiety is brutal. The SSRIs did not work, nor any of the newer ADs. So, I am trying nortriptyline as one of the cleaner TCAs and one not as activating as desipramine. Or so I'm told. I start this Thursday, with a very low dose (liquid form).
Thanks. Dannen
Posted by zeugma on October 28, 2003, at 20:33:35
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 28, 2003, at 12:37:49
> Viridis or Zeugma. Have either of you experience with having blood plasma levels checked after taking nortriptyline? At what point is this done? I read that one should have this done after being at 75 mg for 7 days. Any guidance.
Dannen,
I had my plasma level taken after a month at 60 mg/ day. The trick with nortriptyline is that people metabolize it at very different rates, hence 60 mg a day could be a high dose for one person (while that's fairly unlikely) but low for many others. The plasma level was 'low,' according to my pdoc, so we raised it to 75 mg a day. The response became stronger at that point.
You'll want to titrate up slowly, because nortriptyline tends to have a lot of side effects, that will mostly go away over time. On the other hand, it is much easier on the stomach than a lot of other AD's, and seems to have some kind of anti-nauseant property, in addition to being a good analgesic (its other main use is in conditions of chronic pain, and further up this board there's discussion of its efficacy in migraines).
I still suffer from anxiety- at this point, I am considering a benzodiazepine such as Klonopin prn, for situations that are especially anxiety-provoking. I have a particularly debilitating form of social anxiety, and TCA's generally don't help this condition. They do lower the anxiety level overall. The sedative effect is subtle at low doses- when I was taking 40 mg, I had to take it at 2 pm to get to sleep by midnight (I am a lifetime insomniac). I can take 75 mg at 8 pm to be in bed by 11. It's also made my sleep more restful. A lot of my morning anxiety came from having such bad sleep that I did not feel like a human being when I woke up.
zeugma
>
> Viridis. Thanks for the information on Xanax and Klonopin. Can one take Klonopin every day, without the risk of needing more (i.e., developing a tolerance)? My sister-in-law takes it 5 days on, 2 days off I think. I knew a priest who got up to 20 mg a day. (Yes, that amount seems impossible, but it is true. He was detoxed at a hospital over several months. A very kindhearted man who get horrible advice from his doctor.)
>
> I need an antidepressant that works for anxiety. My morning anxiety is brutal. The SSRIs did not work, nor any of the newer ADs. So, I am trying nortriptyline as one of the cleaner TCAs and one not as activating as desipramine. Or so I'm told. I start this Thursday, with a very low dose (liquid form).
>
> Thanks. Dannen
Posted by dannen on October 28, 2003, at 20:48:33
In reply to Re: Agitated depression; anxiety bad in morning » dannen, posted by zeugma on October 28, 2003, at 20:33:35
Zeugma.
Thanks so much for your help. I am sorry about your social anxiety. Have you ever tried yoga? It is the only thing that really has helped my anxiety. Acupuncture also is very good, if the person knows his/her stuff. But it is tricky treating a mixed state like anxious depression. Yoga and swimming are my main crutches right now.
I do not have trouble falling asleep. It's staying asleep. I fall asleep about 10:30 and awake at about 4:30. And the anxiety starts. Free floating. No bad thoughts or dreams. Just waves of anxiety. I hope nortriptyline can help with that. I will have my blood level checked when I get higher up in the mgs, I guess. I am just starting with 5-10 mgs. this week. I'll work up.
What helps for the side effects--dry mouth and constipation? Is there any counteracting med for that? I might make a post on that.
Again, thanks for caring. I wish you the best in finding that peace that passes all understanding.
Dannen
Posted by zeugma on October 28, 2003, at 22:26:46
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 28, 2003, at 20:48:33
Dannen,
That early wakening is a classic sign, it's called 'terminal insomnia.' It was identified early on in the history of psychopharmacology as a marker of a potential POSITIVE response to TCA's.
The first things nortriptyline did, ata very low dose (20-30 mg a day)were:
cut down on my constant nausea;
stop the kind of anxiety you may be describing, a disruptive feeling I would call an 'inner shivering.'
I hope nortriptyline helps you sleep through the night. I believe that many of its therapeutic actions are mediated through its regulation of the sleep cycle. My sleep problems have always centered around a chaotic sleep schedule, no matter how hard I tried I could not fall asleep at the same time every night. Then when I would sleep it would be the wrong kind of sleep. This os a different problem from yours, but I hope nortriptyline can help you stay asleep until you want to wake up.
The side effects I got early on were lowered blood pressure, headache (from dehydration), aqnd dizziness. The solution was to drink plenty of liquids, which also helps with the constipation and dry mouth, though I didn't get those until I reached a higher dosage. Also, a certain degree of increased emotionality can occur. I believe this drug is a powerful 'normalizer' of emotions, and this can cause some agitation; it's something to watch out for, but I think it is part of the therapeutic action.Thanks for the positive wishes, and wishing you the best in return,
zeugma
Posted by Viridis on October 29, 2003, at 2:35:24
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 28, 2003, at 12:37:49
Hi Dannen,
I don't have any experience with TCAs, so can't help there. Re: Klonopin: I've been taking 1 mg Klonopin per day for 2 1/2 years and haven't changed the dosage except for very rarely taking an extra mg later in the day (only for really intense stress, maybe once a month).
There are no guarantees, but my pdoc says he has many patients who have been on the same dose for years and are doing well. He's offered to increase my dose (1 mg is at the very low end for serious anxiety/panic) but I've had no need so far and don't want to increase it unless I absolutely have to. Generally, I use Xanax for "breakthrough" anxiety, but given my sudden tolerance to Xanax I keep its use to a minimum. It is very helpful as a backup, though, and normally Klonopin is enough anyway.
BTW, Klonopin was originally used for epilepsy, and up to 20 mg/day was/is a pretty common dose for that condition. I can't imagine taking that much! No matter how much you take, though, if you take it for long, you need to diminish the dose gradually should you decide to quit it. This seems to be the case for almost all of these psychiatric meds (and lots of others too, like some blood pressure drugs etc.).
If I were you, I'd give Klonopin a trial for a couple of weeks -- I suspect it will help a lot, especially together with nortriptyline. The morning anxiety syndrome is awful, and I've had plenty of experience with it. I never want to go back there, and will stick with the meds for life if necessary.
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