![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by blueberry on September 23, 2005, at 6:50:10
I'm in a very bad way need help from you pros out there. My GP is calling it anxiety, but I am totally convinced it is tardive akathisia.
Symptoms...upon waking, extreme jitteriness...on the outside it is jittery fingers, jittery knees, shakey elbows, whole body shakiness. Feel extremely caffeinated. On the inside it is worse...hard to put in words...very restless inside...butterflies in the stomach. I can't sit. Pace constantly. I actually am best a work where I am active. My symptoms are purely physical, not psychological.
History...prozac 20mg and zyprexa 5mg for five years, worked good, no side effects. Problems with butterflies in the stomach and dread upon waking started in March this year and have slowly progressively worsened with inner restlessness and jitters. Now 5mg lexapro, 7.5mg remeron, 2.5mg zyprexa, 1.5mg xanax.
Clues...for a 3 month period I dropped prozac down to 10mg and added in 600mg to 900mg st johns wort. My symptoms completely disappeared. Sjw seemed like a miracle. But then it pooped into severe depression. When I weaned off of it, the akathisia returned much worse than before.
Clues...Even though I wake feeling extremely caffeinated upon waking, the first cup of coffee actually calms me down a bit. Strange. The first cigarettes help too. Magnesium glycinate helps.
A one day trial of a higher dose of zyprexa made it much worse. Have cut back to 2.5mg. Lexapro 5mg a day has replaced prozac. I've read that stopping the med that caused akathisia in the first place can actually make it worse.
Zyprexa makes it all go away...but alas, only for about 8 hours. I clock watch all day waiting for my zyprexa dose. Have considered bid or tid dosing of zyprexa, but I know in the long run it will only make things much worse.
Sjw, coffee, cigarettes...these all seem clues to me that it is a dopamine thing.
What do you think are top choices for me to try? Dopamine agonists? I've read they try everything from clonidine to inderal to anticholinergics to benzos to buspar to dopamine agonists to gabapentin to remeron and on and on.
Posted by SLS on September 23, 2005, at 9:11:08
In reply to Pros...Please Help..How to treat Tardive Akathisia, posted by blueberry on September 23, 2005, at 6:50:10
Would you consider discontinuing the Lexapro? It might be a critical component in the expression of the akathisia.
- Scott
Posted by Racer on September 23, 2005, at 12:39:47
In reply to Pros...Please Help..How to treat Tardive Akathisia, posted by blueberry on September 23, 2005, at 6:50:10
First of all, I think you're thinking about Tardive Dyskinesia, which would manifest itself with uncontrolled movements mostly in the facial muscles.
It could be that you're experiencing akathesia, but it really does sound more like intense anxiety to me. That can be physical as well as emotional, so don't rule it out. It's very real.
I'm one of those who experience mostly physical anxiety. I'm rarely aware of any psychological anxiety, and when I am it's usually the effect of the physical symptoms -- I am almost aware of seeking a psychological worry to match the physical response. In fact, I have such intense physical symptoms so constantly that I am often unaware of how anxious I am. What I found that worked miraculously for me was propranalol. About 20 minutes after taking the first dose, I experienced such a profound sense of relaxation that I became aware of just how tense I'd been for so long I didn't even remember what calm felt like.
My own experience, which may be very, very different from yours, was that my system got hypersensitized to anxiety. Once the adrenaline got going, it kept going like the Energizer bunny. A lot like the "kindling" theory, that once your body adapts to that sort of anxiety, it will ramp up much more quickly. A few months on propranalol helped a great deal in resetting my system, though. (I had to stop it because it conflicts with Wellbutrin.)
Additionally, the propranalol dose that works for anxiety tends to be much, much lower than that used for hypertension. I think I was taking about 10mg per day. Since it has few side effects at that sort of dose, that would be my first choice.
My own dear Dr CattleProd says that Buspar is good mostly for the psychological symptoms of anxiety, and then only in some people. If you're not aware of worry, then it might not be the first choice for you.
Again, this is only my experience with benzos, but when I'm anxious, I have to take such high doses of them that I will go into a blackout long before I get calm. Then again, that happened under rather extreme circumstances, so it might not be typical...
I hope that helps some. I have never had my own akathesia treated, so don't know what might help. I have experienced it, though, and just stopping the med involved wasn't enough to stop it. I still have mild symptoms, but I'm also on a ton of meds now myself, so who knows what's really involved.
Good luck.
Posted by blueberry on September 23, 2005, at 16:37:01
In reply to Pros...Please Help..How to treat Tardive Akathisia, posted by blueberry on September 23, 2005, at 6:50:10
SLS and Racer...thank you very much for your response. I appreciate that very much.
SLS, yes I would consider dropping the lexapro, but I'm on such a micro dose. My mood is actually good, but maybe I'll try dropping it down to 2.5 tomorrow. Since I stopped the prozac about a week ago, I would guess I still have about 5mg to 10mg of it in my system. It's weird how I handled 20mg for years like it was candy, dropped down to 10mg, then when tried going back to my usual 20mg found it impossible.
Racer, that's great info on the inderal. I was afraid of that one because I have naturally low blood pressure to begin with. But I wasn't aware until you told me that only small doses are needed, so that sounds encouraging. It does "feel" like if I could just lower noradrenaline somehow I would be much better.
Feel like I'm going 1000mph inside, with shakey fingers that bounce off the keyboard. But no psychological anxiety at all.
If you think of anything else or want to comment further on anxiety or akathisia, please do. I'm all ears.
Posted by spriggy on September 23, 2005, at 16:42:50
In reply to Re: How to treat Tardive Akathisia...SLS Racer, posted by blueberry on September 23, 2005, at 16:37:01
Posted by Racer on September 23, 2005, at 20:43:21
In reply to Re: How to treat Tardive Akathisia...SLS Racer, posted by blueberry on September 23, 2005, at 16:37:01
My usual blood pressure is about 90/60, with fluctuations to about 85/50. I took propranalol with no problems.
Hope that helps...
Posted by Phillipa on September 23, 2005, at 22:21:57
In reply to Hypotension and propranalol » blueberry, posted by Racer on September 23, 2005, at 20:43:21
I thought St. John's Wart was contraindicated with SSRI's? Fondly, Phillipa
Posted by ButterflyHIgh on September 24, 2005, at 2:13:47
In reply to Pros...Please Help..How to treat Tardive Akathisia, posted by blueberry on September 23, 2005, at 6:50:10
Have you asked your prescribing physician about Cogentin?
*thumbs up*
Posted by Cairo on September 24, 2005, at 20:28:05
In reply to Hypotension and propranalol » blueberry, posted by Racer on September 23, 2005, at 20:43:21
Would pindolol be any better, in your opinion? I've been toying with asking for a beta-blocker for a long while as I've that wound up anxiety such as you described, but I have postural dizziness all the time. A tilt table test was "normal", though my lower legs turned purple. I've taken my own blood pressure in bed, getting up, etc. and sometimes it goes down instead of up upon arising. Only Cymbalta at 5mg seemed to help with the postural dizziness.
I read somewhere that if your BARS receptors (beta adrenergic receptor) are hypersensitive, giving an SSRI along with other medications with SSRI effects (such as trazodone)adversely impacts the BARS receptors. The researcher (I think P. Wood MD at LSU) said that using Pindolol or Inderal would help "reset" the BARS. Can't find my link to that info, though and couldn't bring it up on PubMed.
My Pdoc won't prescribe Inderal for me as he's worried about the BP. I want to get off Klonopin that I needed to start for panic attacks induced by Topamax. Maybe I need to talk to my Internist. She's pretty sharp and maybe would look into it for me.
Have you heard anything about this BARS and SSRIs?
Thanks.
Cairo
> My usual blood pressure is about 90/60, with fluctuations to about 85/50. I took propranalol with no problems.
>
> Hope that helps...
Posted by Racer on September 24, 2005, at 21:11:47
In reply to Re: Hypotension and propranalol » Racer, posted by Cairo on September 24, 2005, at 20:28:05
> Would pindolol be any better, in your opinion? I've been toying with asking for a beta-blocker for a long while as I've that wound up anxiety such as you described, but I have postural dizziness all the time. A tilt table test was "normal", though my lower legs turned purple. I've taken my own blood pressure in bed, getting up, etc. and sometimes it goes down instead of up upon arising. Only Cymbalta at 5mg seemed to help with the postural dizziness.
>
> I read somewhere that if your BARS receptors (beta adrenergic receptor) are hypersensitive, giving an SSRI along with other medications with SSRI effects (such as trazodone)adversely impacts the BARS receptors. The researcher (I think P. Wood MD at LSU) said that using Pindolol or Inderal would help "reset" the BARS. Can't find my link to that info, though and couldn't bring it up on PubMed.
>
> My Pdoc won't prescribe Inderal for me as he's worried about the BP. I want to get off Klonopin that I needed to start for panic attacks induced by Topamax. Maybe I need to talk to my Internist. She's pretty sharp and maybe would look into it for me.
>
> Have you heard anything about this BARS and SSRIs?
>
> Thanks.
>
> Cairo
>
> >I haven't read anything about it, no, but I suspect that a doctor who won't prescribe propranalol is unlikely to prescribe pindolol, either? Wouldn't you think? I have a problem with postural hypotension, but also with a sort of idiopathic hypotension -- I can be walking along, happy as a clam at high tide, and suddenly drop. Happens when I stand for any length of time, too, unless I fidget a LOT. {shrug} Idiopathic, heavy emphasis on the IDIO...
If the fact that the dose of a beta blocker used for anxiety is so much less than the dose for hypertension doesn't sway your doctor, it might be worth asking about a calcium channel blocker. Verapamil is the one I've heard most about as a mood stabilizer and anxiolytic. If propranalol hadn't worked for me, that's what I would have asked for.
Hope that helps.
Posted by Ilene on September 24, 2005, at 21:19:16
In reply to Re: Pros...Please Help..How to treat Tardive Akath, posted by Racer on September 23, 2005, at 12:39:47
Racer, what you said is really interesting, because just yesterday my regular doc said Inderal might fix a tremor I developed a few months ago. He knows I take Wellbutrin. I had blood drawn for a thyroid workup, and he wants to see the results before he prescribes anything.
Thanks,
I.
Posted by Ilene on September 24, 2005, at 21:27:17
In reply to Re: Hypotension and propranalol, posted by Racer on September 24, 2005, at 21:11:47
> I haven't read anything about it, no, but I suspect that a doctor who won't prescribe propranalol is unlikely to prescribe pindolol, either? Wouldn't you think? I have a problem with postural hypotension, but also with a sort of idiopathic hypotension -- I can be walking along, happy as a clam at high tide, and suddenly drop. Happens when I stand for any length of time, too, unless I fidget a LOT. {shrug} Idiopathic, heavy emphasis on the IDIO...
>Sounds like neurally mediated hypotension, which is why I'm taking fludrocortisone. I can really feel it if I forget to take it. I've never passed out and don't want to. I don't like it when things fade out and I see stars.
I.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.