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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by 4WD on May 15, 2005, at 14:43:46
I've been on nortriptyline 25mg for three and a half weeks now. AT first I felt better but in the last few days, my anxiety level has gone sky high. Is this to be expected? Should I keep on going with the nortript? I know some SSRIs cause an initial elevation in anxiety and I'm taking the nortript to try and help with anxiety. I need help please.
Marsha
Posted by Ritch on May 15, 2005, at 16:19:34
In reply to starting nortriptyline -increased anxiety HELP!, posted by 4WD on May 15, 2005, at 14:43:46
> I've been on nortriptyline 25mg for three and a half weeks now. AT first I felt better but in the last few days, my anxiety level has gone sky high. Is this to be expected? Should I keep on going with the nortript? I know some SSRIs cause an initial elevation in anxiety and I'm taking the nortript to try and help with anxiety. I need help please.
>
> MarshaIs the anxiety from the NT mostly "physical" or is it more worrisome ruminations? NT really helped me with worry-type anxiety, BUT I did get a little "shakey" on the stuff, even stuttered a little from time to time, skin-crawling "scary movie" sensations, etc. That's kind of strange that you felt better right away on it, but things seem to have worsened. (Usually it is the reverse on TCA's) Are you taking any other meds?
Posted by 4WD on May 15, 2005, at 16:31:54
In reply to Re: starting nortriptyline -increased anxiety HELP! » 4WD, posted by Ritch on May 15, 2005, at 16:19:34
>
> Is the anxiety from the NT mostly "physical" or is it more worrisome ruminations? NT really helped me with worry-type anxiety, BUT I did get a little "shakey" on the stuff, even stuttered a little from time to time, skin-crawling "scary movie" sensations, etc. That's kind of strange that you felt better right away on it, but things seem to have worsened. (Usually it is the reverse on TCA's) Are you taking any other meds?
It's hard to describe. It's an unnameable terror that starts in my chest and stomach. Rumination is also part of it. I can't let myself think about anything remotely scary (like opening the mail or making a phone call) or else the terror will mount. Usually it does anyway, until I'm crying because I'm so terrified. And there's a component of deep emotional pain and despair. I've had this since before being on the nortriptyline but it has gotten much worse in the last week (fourth week on nort).When I first started the nort. I had more energy and a slight brightening in mood. Then that went away and I was about the same for a couple of weeks. Now the fear has grown into terror.
I am also trying beta blockers for anxiety but can't tell they do anything except slow down my heart rate somewhat and reduce the trembling.
I take Celexa 10mg, Nort. 25 mg., propanolol 10mg t.i.d. or b.i.d. and Klonopin .5mg as needed. I've avoided the Klonopin unless I get to the point where I'm suicidal from the terror.
Any advice appreciated.Fear and Trembling,
Marsha
Posted by Ritch on May 15, 2005, at 18:11:57
In reply to Unnameable Terror » Ritch, posted by 4WD on May 15, 2005, at 16:31:54
>
> >
> > Is the anxiety from the NT mostly "physical" or is it more worrisome ruminations? NT really helped me with worry-type anxiety, BUT I did get a little "shakey" on the stuff, even stuttered a little from time to time, skin-crawling "scary movie" sensations, etc. That's kind of strange that you felt better right away on it, but things seem to have worsened. (Usually it is the reverse on TCA's) Are you taking any other meds?
>
>
> It's hard to describe. It's an unnameable terror that starts in my chest and stomach. Rumination is also part of it. I can't let myself think about anything remotely scary (like opening the mail or making a phone call) or else the terror will mount. Usually it does anyway, until I'm crying because I'm so terrified. And there's a component of deep emotional pain and despair. I've had this since before being on the nortriptyline but it has gotten much worse in the last week (fourth week on nort).
>
> When I first started the nort. I had more energy and a slight brightening in mood. Then that went away and I was about the same for a couple of weeks. Now the fear has grown into terror.
>
> I am also trying beta blockers for anxiety but can't tell they do anything except slow down my heart rate somewhat and reduce the trembling.
>
> I take Celexa 10mg, Nort. 25 mg., propanolol 10mg t.i.d. or b.i.d. and Klonopin .5mg as needed. I've avoided the Klonopin unless I get to the point where I'm suicidal from the terror.
> Any advice appreciated.
>
> Fear and Trembling,
>
> Marsha
>
>Hmmm. It sounds like the meds are over activating you, just a hunch. The beta-blocker got added to stop the "shakiness" from the NT right? The NT got added because... the Celexa wasn't working good enough for the anxiety? Maybe the primary drug (Celexa) isn't doing the job? What's your dx?
Posted by Interested on May 15, 2005, at 21:27:07
In reply to Re: Unnameable Terror » 4WD, posted by Ritch on May 15, 2005, at 18:11:57
Nortriptyline usually doesn't cause anxiety. It's in the tricyclic family, and they are even given for sleeping aids. It's also prescribed sometimes as a muscle relaxer. So you should get some relaxing effect from Nortiptyline. I took it for years, and the only negative side effect was weight gain.
Posted by 4WD on May 15, 2005, at 22:24:49
In reply to Re: Unnameable Terror » 4WD, posted by Ritch on May 15, 2005, at 18:11:57
> Hmmm. It sounds like the meds are over activating you, just a hunch. The beta-blocker got added to stop the "shakiness" from the NT right? The NT got added because... the Celexa wasn't working good enough for the anxiety? Maybe the primary drug (Celexa) isn't doing the job? What's your dx?
Dx is major depression and anxiety disorder (used to be just GAD). Yes, the beta blocker was an attempt to avoid having to take Klonopin every day. The NT was added because I was still very anxious on the Celexa and still depressed. But I've already been through Prozac, Effexor, Paxil (caused panic), Lexapro and Wellbutrin. All of them worked in the sense they brought me out of major depression up into just plain dysthymia but side effects were real bad with some. And none of them actually worked well anymore after my first ten years on ADs.
It's weird. Sometimes at night, it all just goes away and I feel like a normal person. A switch clicks, the anxiety starts to dissipate, I'm no longer depressed and I actually have moments of feeling almost happy. Then I wake up the next morning full of terror which leads to despair and that state lasts most of the day.
Depression sucks.
Marsha
Posted by Ritch on May 16, 2005, at 10:26:42
In reply to Re: Unnameable Terror » Ritch, posted by 4WD on May 15, 2005, at 22:24:49
> > Hmmm. It sounds like the meds are over activating you, just a hunch. The beta-blocker got added to stop the "shakiness" from the NT right? The NT got added because... the Celexa wasn't working good enough for the anxiety? Maybe the primary drug (Celexa) isn't doing the job? What's your dx?
>
> Dx is major depression and anxiety disorder (used to be just GAD). Yes, the beta blocker was an attempt to avoid having to take Klonopin every day. The NT was added because I was still very anxious on the Celexa and still depressed. But I've already been through Prozac, Effexor, Paxil (caused panic), Lexapro and Wellbutrin. All of them worked in the sense they brought me out of major depression up into just plain dysthymia but side effects were real bad with some. And none of them actually worked well anymore after my first ten years on ADs.
>
> It's weird. Sometimes at night, it all just goes away and I feel like a normal person. A switch clicks, the anxiety starts to dissipate, I'm no longer depressed and I actually have moments of feeling almost happy. Then I wake up the next morning full of terror which leads to despair and that state lasts most of the day.
>
> Depression sucks.
> Marsha
>
>
Does it seem that anxiety and stress seem to come first and then the depression gets worse afterwards? When you used the beta-blocker to try to substitute for clonazepam.. it seemed that things got worse (also perhaps some clon withdrawal there?). Maybe your doc should aggressively target anxiety and then the depression would take care of itself? If an AD makes your anxiety worse.. (you said Paxil *caused* panic), then perhaps look at an AD that *doesn't* make your anxiety worse. Perhaps that would be a more fruitful strategy. Perhaps an MAOI or a different tricyclic would work better (i.e. doxepin, amitriptyline, imipramine)?
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