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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Jeffrey on February 29, 2004, at 21:33:27
Hi,
I have posted several times in the past as I have made changes to my meds.
Currently, I am on 150 mg Effexor XR, Celexa 60 mg and clonazepam about 1 mg day.
I have anxiety that has led to depression.
I have the physical symptoms of anxiety/depression. I wake up each morning and am reminded that things are not well with me and that I have something I am worrying about, that I will have to worry about forever (low risk health issues with my child)(objectively not very serious but I have been anxious/dpressed/obsessed about it.)
Before this episode, I had 3 years without any meds and was in complete remission from anxiety/depression.
I have tried augmentation with neurontin. That provided a little bit of relief but I think the Clonazepam is better.
Does anyone think I would benefit from an anti-psychotic? Any other ideas?
I am a full time lawyer who is struggling but must perform at work every day but cannot live with this anxiety and depression. I am not suicidal but very, very frustrated and going through one terrible day after the next.
Thank you to everyone.
Posted by rainee on February 29, 2004, at 23:05:08
In reply to Anxiety Augmentation -Help Needed Please, posted by Jeffrey on February 29, 2004, at 21:33:27
If you are not doing well it is time for a change.
I for one stayed on prozac for years when I should have been off.
Anxiety disorder is no fun. That uneasy feeling that naws away sometimes giving way to panic ..sucking the life out of you.. talk to your doc about an antipsychotic
. If this Doc does't seem to be getting it seek out another.
I feel for you I am and have been there. Right now I'm off SSRI's I found I'm bipolar II and need stabilizers. I take abilify and might have to add a stabilizer such as lamictal but I'm taking it slow. I also am taking klonopin.
take care hang in..also are you in therapy?Rainee
Posted by nicky847 on March 3, 2004, at 14:24:32
In reply to Re: Anxiety Augmentation -Help Needed Please » Jeffrey, posted by rainee on February 29, 2004, at 23:05:08
Jeffrey have you tried CBT? It could be a helpful thing for you...many people struggle with anxiety disorder and cannot pinpoint why they feel the way they do..i think that since you in large part know the source of your anxiety that CBT can be a very good thing for you to help you deal with the situation in a healthy way..
> If you are not doing well it is time for a change.
> I for one stayed on prozac for years when I should have been off.
> Anxiety disorder is no fun. That uneasy feeling that naws away sometimes giving way to panic ..sucking the life out of you.. talk to your doc about an antipsychotic
> . If this Doc does't seem to be getting it seek out another.
> I feel for you I am and have been there. Right now I'm off SSRI's I found I'm bipolar II and need stabilizers. I take abilify and might have to add a stabilizer such as lamictal but I'm taking it slow. I also am taking klonopin.
> take care hang in..also are you in therapy?
>
> Rainee
Posted by Jeffrey on March 6, 2004, at 13:00:05
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by nicky847 on March 3, 2004, at 14:24:32
I am in CBT therapy. I am having some success but not enough. Thanks for your responses. Have a great weekend.
Posted by bark2323 on March 7, 2004, at 14:39:18
In reply to Anxiety Augmentation -Help Needed Please, posted by Jeffrey on February 29, 2004, at 21:33:27
Well you might just try raising your klonopin dose, assuming your doc is willing. While Ive heard people get relief from like .25mg a day, I need 4mg, and others higher than that.
You said you augmented with neurontin, but klonopin is better, which sounds like you actually didnt take the 2 at the same time. If thats true, why not try that?
Antipsychotics can work very well (zyprexa is the one Ive found best), but you might want to think about other things first, depending on what you think of their side effects. They can also help with depression (the atypicals anyway).
matt
Posted by Jeffrey on March 7, 2004, at 17:21:07
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by bark2323 on March 7, 2004, at 14:39:18
> Well you might just try raising your klonopin dose, assuming your doc is willing. While Ive heard people get relief from like .25mg a day, I need 4mg, and others higher than that.
> You said you augmented with neurontin, but klonopin is better, which sounds like you actually didnt take the 2 at the same time. If thats true, why not try that?
> Antipsychotics can work very well (zyprexa is the one Ive found best), but you might want to think about other things first, depending on what you think of their side effects. They can also help with depression (the atypicals anyway).
> mattThanks for your reply Matt. I have decided with my pdoc I will begin to lower my Effexor and move up with the celexa to 80 mg (which is considered very high I understand) and use clonazepam liberally.
I don't think atypical antipsychotics are the right choice at this time for my depression and anxiety. I cannot afford losing the sharpness my mind has now despite the anxiety and depression. I fear that the AP might make me more drousy and out of it. I am a lawyer, somehow managing my workload.
Thanks again very much. Any further thoughts are appreciated.
Posted by micro on March 7, 2004, at 18:23:36
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by Jeffrey on March 7, 2004, at 17:21:07
> > Well you might just try raising your klonopin dose, assuming your doc is willing. While Ive heard people get relief from like .25mg a day, I need 4mg, and others higher than that.
> > You said you augmented with neurontin, but klonopin is better, which sounds like you actually didnt take the 2 at the same time. If thats true, why not try that?
> > Antipsychotics can work very well (zyprexa is the one Ive found best), but you might want to think about other things first, depending on what you think of their side effects. They can also help with depression (the atypicals anyway).
> > matt
>
> Thanks for your reply Matt. I have decided with my pdoc I will begin to lower my Effexor and move up with the celexa to 80 mg (which is considered very high I understand) and use clonazepam liberally.
>
> I don't think atypical antipsychotics are the right choice at this time for my depression and anxiety. I cannot afford losing the sharpness my mind has now despite the anxiety and depression. I fear that the AP might make me more drousy and out of it. I am a lawyer, somehow managing my workload.
>
> Thanks again very much. Any further thoughts are appreciated.
>Jeff, I would like to help, but I do not know the etiology of your anxiety or your diagnosis.
As you know some meds cause anxiety as well, so it is important to know if your current therapy is not inducing any relaxation Why? Remember, that what is works well for others may not be pharmacologically compatible with you!Regards, Micro
Posted by Jeffrey on March 7, 2004, at 20:18:28
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by micro on March 7, 2004, at 18:23:36
> > > Well you might just try raising your klonopin dose, assuming your doc is willing. While Ive heard people get relief from like .25mg a day, I need 4mg, and others higher than that.
> > > You said you augmented with neurontin, but klonopin is better, which sounds like you actually didnt take the 2 at the same time. If thats true, why not try that?
> > > Antipsychotics can work very well (zyprexa is the one Ive found best), but you might want to think about other things first, depending on what you think of their side effects. They can also help with depression (the atypicals anyway).
> > > matt
> >
> > Thanks for your reply Matt. I have decided with my pdoc I will begin to lower my Effexor and move up with the celexa to 80 mg (which is considered very high I understand) and use clonazepam liberally.
> >
> > I don't think atypical antipsychotics are the right choice at this time for my depression and anxiety. I cannot afford losing the sharpness my mind has now despite the anxiety and depression. I fear that the AP might make me more drousy and out of it. I am a lawyer, somehow managing my workload.
> >
> > Thanks again very much. Any further thoughts are appreciated.
> >
>
> Jeff, I would like to help, but I do not know the etiology of your anxiety or your diagnosis.
> As you know some meds cause anxiety as well, so it is important to know if your current therapy is not inducing any relaxation Why? Remember, that what is works well for others may not be pharmacologically compatible with you!
>
> Regards, Micro
>
Micro,Thanks for your willingness to help.
The following is some backgroud to my situation:
I have anxiety stemming from my unborn baby being exposed to an abdominal x-ray before my wife knew she was pregnant. There is an increased risk of some cancers to the baby from this type of exposure. However, this risk is insignificant and I have been advised by Doctors not to worry about the exposure as it is more likely that cancer would occur spontaneously etc.
My anxiety manifests physically (I am never relaxed feeling and generally physically nervous) and mentally with obsessive worrying.
Anyway, I worried obsessively about this and could not concentrate on anything and developed depression as a result. I fear I will never be able to enjoy the baby and that this worry will not go away. To say the least, my wife's pregancy has been miserable for me. I had been very excited for having a baby before this anxiety began.
I began taking Effexor, as it had helped me in the past (at 75mg XR) achieve complete remission from anxiety that resulted from a very low risk sexual encounter which I feared had given me HIV. In that case I got the HIV test and it was negative and began my life again and gradually went off the Effexor and did not have an episode of anxiety for 2+ years without any medication. In this current situation, there is no "test" and I am left with complete uncertainty of whether the x-ray had any negative effects.
I took Effexor up to 300 mg XR and there was some response but nothing great. I moved down to 150 mg XR and began Celexa and I am now taking 60 mg a day. I have responded better to the Celexa but still am "not myself" and I am continually worried with low level depression.
Despite this anxiety/depression, I can function in work and social situations ok.
I see friends socially, and maintain a law practice.I have taken about .75 mg a day of clonazepam throughout this episode which began in August. The baby is due any week now...
I am desperate and just want to feel better and get over this and enjoy my life and my baby.
I was thinking of lowering my Effexor and upping the Celexa to a very high dose.
Thanks for your concern. Any thoughts are appreciated. Best regards, Jeffrey
Posted by nmk on March 8, 2004, at 13:26:45
In reply to Anxiety Augmentation -Help Needed Please, posted by Jeffrey on February 29, 2004, at 21:33:27
Jeffrey,
I am sorry you are going through such a terrible time now. I know all too well how it feels to be in such mixed states.....depression coupled with crushing anxiety and agitation. I tried effexor but it exacerbated the anxiety and made me feel too "spacey". After a two-year med trial period of everything known to man, I have been pretty stable on 50 mg of zoloft in the am and 2 mg of Klonopin and 2.5 mg of zyprexa at night for sleep. The night time med combo relaxes me, decreases the anxiety, and allows me to sleep peacefully. I do feel a tad foggy in the morning but after two cups of coffee, I am fine. I am also a professional and need to keep my mind sharp so the zyprexa scared me at first. I have found that the minor side effects I experience with the experience is well worth it. You may want to ask your pdoc about increasing your Klonopin dose first and if that doesn't help, adding a small dose of zyprexa or seroquel.
I hope today was a better day for you.
Sincerely,
Nicole
Posted by Jeffrey on March 8, 2004, at 17:43:39
In reply to Re: Anxiety Augmentation -Help Needed Please » Jeffrey, posted by nmk on March 8, 2004, at 13:26:45
> Jeffrey,
>
> I am sorry you are going through such a terrible time now. I know all too well how it feels to be in such mixed states.....depression coupled with crushing anxiety and agitation. I tried effexor but it exacerbated the anxiety and made me feel too "spacey". After a two-year med trial period of everything known to man, I have been pretty stable on 50 mg of zoloft in the am and 2 mg of Klonopin and 2.5 mg of zyprexa at night for sleep. The night time med combo relaxes me, decreases the anxiety, and allows me to sleep peacefully. I do feel a tad foggy in the morning but after two cups of coffee, I am fine. I am also a professional and need to keep my mind sharp so the zyprexa scared me at first. I have found that the minor side effects I experience with the experience is well worth it. You may want to ask your pdoc about increasing your Klonopin dose first and if that doesn't help, adding a small dose of zyprexa or seroquel.
>
> I hope today was a better day for you.
>
> Sincerely,
>
> NicoleThanks Nicole for your thoughtful response.
Did Zyprexa "space you out" at all or make you feel unlike yourself? I now am very worried and unhappy that I am worrying all the time over such a low risk thing but I can mostly conduct myself like I do when I am healthy. I have no psychotic features whatsoever (other than dwelling on such a low risk as f its a big risk). I can see friends, family and I would appear normal to them (Unlike before the current Celxa/Effexor/Clonazepam cocktail where I looked anxious/pale/depressed).
I want to know if the drug is likely to make me feel better ie more relaxed but still myself. I had an unpleasant experience on Remeron, where I was spaced out and very uncomfortable - feeling drowsy etc.
What can I expect from an AP drug in very small dose? Is there anti-depression benefit? Will I not worry as much?
Any thoughts or further insight are appreciated. Thanks for your empathetic response. It helps to know that others go through these difficult experiences.
By the way, how much better are you on your current meds? Were you on no drugs before 2 years ago. I am particulaly interested because you are a professional and must manage to be 'together', in order to function well.
Thanks for your time, Jeffrey
Posted by nmk on March 9, 2004, at 9:17:15
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by Jeffrey on March 8, 2004, at 17:43:39
> Thanks Nicole for your thoughtful response.
>
> Did Zyprexa "space you out" at all or make you feel unlike yourself? I now am very worried and unhappy that I am worrying all the time over such a low risk thing but I can mostly conduct myself like I do when I am healthy. I have no psychotic features whatsoever (other than dwelling on such a low risk as f its a big risk). I can see friends, family and I would appear normal to them (Unlike before the current Celxa/Effexor/Clonazepam cocktail where I looked anxious/pale/depressed).
>
> I want to know if the drug is likely to make me feel better ie more relaxed but still myself. I had an unpleasant experience on Remeron, where I was spaced out and very uncomfortable - feeling drowsy etc.
>
> What can I expect from an AP drug in very small dose? Is there anti-depression benefit? Will I not worry as much?
>
> Any thoughts or further insight are appreciated. Thanks for your empathetic response. It helps to know that others go through these difficult experiences.
>
> By the way, how much better are you on your current meds? Were you on no drugs before 2 years ago. I am particulaly interested because you are a professional and must manage to be 'together', in order to function well.
>
> Thanks for your time, Jeffrey
>
Hi Jeffrey,I have tried taking 2.5 mg of zyprexa during the day and all I wanted to do was sleep. It definately relaxed me but I was not able to function in a normal capacity. I remember carrying my baby and almost falling down the stairs. Therefore, I will NEVER take it during the day and only take it two hours before bed. I don't know if it is the zyprexa, the klonopin, or the combonation, but this cocktail seems to work better for me than any other night-time cocktail I have tried. Remember, 2.5 mg is the lowest dose of zyprexa and although you may feel a bit groggy in the morning, this will dissipate after an hour or so. I have a friend who takes 7.5 mg at night and does not have any negative side effects in the am so it all depends on the person. I just feel that with your high level of anxiety, you need to increase your klonopin and/or add a pinch of zyprexa....at night of course.
Regarding the AD benefit, I do think there is one for me. Since my depression is fueled by my anxiety, my current meds do help in this department and I haven't had an episode of major depression in months.
My med trials started two years ago after the birth of my baby when I suffered severe post-partum anxiety/depression. I tried every AD and even two mood stabilizers, all to no avail. It was when I tapered off everything and addressed the anxiety issue that I started to feel better. Prior to all of this, I was on 50 mg of zoloft and .5 mg of klonopin for 7 years after my twins were born and I went through my first bout of PPD. This worked well for the anxiety and depression but after the second pregnancy, this cocktail wasn't enough and that is when all the med trials began.
Now, I finally feel back to my old neurotic self and have come to accept the fact that I may need meds for the rest of my life to function "normally".
Please discuss all options with your doctor and don't rule out the zyprexa. This miracle med is frequently used for anxiety, agitation, and insomnia and may work well for you.
Please let me know how you are doing. BTW, have you been diagnosed with OCD or GAD? Just curious.
Take Care,
Nicole
Posted by Jeffrey on March 9, 2004, at 11:28:27
In reply to Re: Anxiety Augmentation -Help Needed Please » Jeffrey, posted by nmk on March 9, 2004, at 9:17:15
> > Thanks Nicole for your thoughtful response.
> >
> > Did Zyprexa "space you out" at all or make you feel unlike yourself? I now am very worried and unhappy that I am worrying all the time over such a low risk thing but I can mostly conduct myself like I do when I am healthy. I have no psychotic features whatsoever (other than dwelling on such a low risk as f its a big risk). I can see friends, family and I would appear normal to them (Unlike before the current Celxa/Effexor/Clonazepam cocktail where I looked anxious/pale/depressed).
> >
> > I want to know if the drug is likely to make me feel better ie more relaxed but still myself. I had an unpleasant experience on Remeron, where I was spaced out and very uncomfortable - feeling drowsy etc.
> >
> > What can I expect from an AP drug in very small dose? Is there anti-depression benefit? Will I not worry as much?
> >
> > Any thoughts or further insight are appreciated. Thanks for your empathetic response. It helps to know that others go through these difficult experiences.
> >
> > By the way, how much better are you on your current meds? Were you on no drugs before 2 years ago. I am particulaly interested because you are a professional and must manage to be 'together', in order to function well.
> >
> > Thanks for your time, Jeffrey
> >
>
>
> Hi Jeffrey,
>
> I have tried taking 2.5 mg of zyprexa during the day and all I wanted to do was sleep. It definately relaxed me but I was not able to function in a normal capacity. I remember carrying my baby and almost falling down the stairs. Therefore, I will NEVER take it during the day and only take it two hours before bed. I don't know if it is the zyprexa, the klonopin, or the combonation, but this cocktail seems to work better for me than any other night-time cocktail I have tried. Remember, 2.5 mg is the lowest dose of zyprexa and although you may feel a bit groggy in the morning, this will dissipate after an hour or so. I have a friend who takes 7.5 mg at night and does not have any negative side effects in the am so it all depends on the person. I just feel that with your high level of anxiety, you need to increase your klonopin and/or add a pinch of zyprexa....at night of course.
>
> Regarding the AD benefit, I do think there is one for me. Since my depression is fueled by my anxiety, my current meds do help in this department and I haven't had an episode of major depression in months.
>
> My med trials started two years ago after the birth of my baby when I suffered severe post-partum anxiety/depression. I tried every AD and even two mood stabilizers, all to no avail. It was when I tapered off everything and addressed the anxiety issue that I started to feel better. Prior to all of this, I was on 50 mg of zoloft and .5 mg of klonopin for 7 years after my twins were born and I went through my first bout of PPD. This worked well for the anxiety and depression but after the second pregnancy, this cocktail wasn't enough and that is when all the med trials began.
>
> Now, I finally feel back to my old neurotic self and have come to accept the fact that I may need meds for the rest of my life to function "normally".
>
> Please discuss all options with your doctor and don't rule out the zyprexa. This miracle med is frequently used for anxiety, agitation, and insomnia and may work well for you.
>
> Please let me know how you are doing. BTW, have you been diagnosed with OCD or GAD? Just curious.
>
> Take Care,
>
> Nicole
>
>Thanks for taking time to repond. I do not fit into either GAD or OCD under DSM-IV. I have features of both. When my mind is not distracted I tend to worry about this low risk fear. This causes physical anxiety in my body and depression because I am not able to enjoy life as I once could easily. I enjoy so many things-hobbies, friends. This anxiety is just eating away at my enjoyment of life. I have always wanted a baby and now that I am having one-this happpens.
When you say yoiu are back to your "old neurotic self" does that mean back to normal. ie all is well. Its a pleasure to correspond with you. Best regards, Jeffrey
Posted by nmk on March 9, 2004, at 11:47:45
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by Jeffrey on March 9, 2004, at 11:28:27
> When you say yoiu are back to your "old neurotic self" does that mean back to normal. ie all is well. Its a pleasure to correspond with you. Best regards, Jeffrey
Yes, that does mean I am back to normal. I am just a little compulsive and overly-conscientious. Have always been and will always be, with or without the meds. The meds just keep me in balance so I don't become overwhelmed with anxiety to the point where I cannot function.Also, you WILL enjoy your baby once you get the anxiety under control and feel like your old self again. Yes, having a baby does evoke feelings of anxiety since it is such a major life event and you don't know what to expect. But you will adjust through trial and error and come to realize that this miracle you have created will enrich your life forever.
Nicole
Posted by Jeffrey on March 9, 2004, at 13:22:17
In reply to Re: Anxiety Augmentation -Help Needed Please » Jeffrey, posted by nmk on March 9, 2004, at 11:47:45
> > When you say yoiu are back to your "old neurotic self" does that mean back to normal. ie all is well. Its a pleasure to correspond with you. Best regards, Jeffrey
>
>
> Yes, that does mean I am back to normal. I am just a little compulsive and overly-conscientious. Have always been and will always be, with or without the meds. The meds just keep me in balance so I don't become overwhelmed with anxiety to the point where I cannot function.
>
> Also, you WILL enjoy your baby once you get the anxiety under control and feel like your old self again. Yes, having a baby does evoke feelings of anxiety since it is such a major life event and you don't know what to expect. But you will adjust through trial and error and come to realize that this miracle you have created will enrich your life forever.
>
> Nicole
>
>
>
>Glad to hear you are better. Your words are very kind and reassuring. Thanks for your good wishes. I will try to keep in touch on this board and hopefully will report a complate recovery. It seems so far from that at this stage. Best wishes, Jeffrey
Posted by Keith Talent on March 9, 2004, at 23:58:53
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by Jeffrey on March 9, 2004, at 13:22:17
Jeffrey, you could replace the Celexa and Effexor with clomipramine. It acts in the same way as those two, only with greater potency. Other than that, you would probably do well to keep a fairly high blood level of the clonazepam at all times.
Posted by ryan312 on March 10, 2004, at 1:04:19
In reply to Anxiety Augmentation -Help Needed Please, posted by Jeffrey on February 29, 2004, at 21:33:27
Hi Jeffrey. Sounds like you are really struggling with all of this. Lamictal is being used by many psychiatrists now for unipolar depression with success. I am just about to start it myself for that. It's been used for a while now for Bipolar.
Also, some people have success with augmenting their SSRI's with a small amount of lithium or synthroid (even if no thyroid problem exists).
These are all things to keep in mind for further discussion with your doc if upping your Celexa doesn't help the depression. Also, I would want to make sure you are not possibly Bipolar type 2 as hypomanic episodes are so often missed and many people do respond to the bipolar meds who were thought to be unipolar.
I think upping your klonopin, as you mentioned, is a good idea till you get a little more stable.
Take care...
Posted by Jeffrey on April 4, 2004, at 19:46:19
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by ryan312 on March 10, 2004, at 1:04:19
Thanks to evrtyone for their supportive posts. I will update if anything improves. Best regards, Jeffrey
Posted by CK1 on January 13, 2005, at 16:03:13
In reply to Re: Anxiety Augmentation -Help Needed Please, posted by Jeffrey on April 4, 2004, at 19:46:19
Jeffrey,
I know exactly what you're going through. Anxiety is a major cause of depression because it inhibits everything you do and, until meds kick in, it's all you think about!
I am a college student and had HUGE success with Paxil 10mg and Ritalin 10mg for my social anxiety during my senior year in high school. After 6 weeks, I was talking to girls I never thought I'd talk to and partying, etc.
Two years later, I weaned off because I didn't like the sexual side effects and, upon my return to college, found myself living in the fraternity house with two roomates in one room and ANXIOUS AS EVER! Tried Klonopin which worked very well, but couldn't take long term. Went back on Paxil 10mg and life was awesome again until a month ago. I've been on 20mg for 8 days and my doctor prescribed Provigil instead of Ritalin because of tolerance.
When we're feeling great, we take if for granted! I can't wait to get back to feeling "normal" and going on dates again!
This is the end of the thread.
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