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Dr. Bob is Robert Hsiung, MD,
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Posted by Maxime on February 7, 2008, at 14:39:46
In reply to ssri's and anxiety, posted by johnj on February 7, 2008, at 14:09:50
Hi John
Anxiety is awful. SSRIs can help, but in your case it doesn't look like it. Most people get tired on Luvox.
Seroquel might be good for your anxiety.The tricyclic anti depressant Clomipramine use to be the gold-standard for OCD before the SSRIs came along. Maybe that would help.
If you want to try another SSRI go for Lexapro as it is sedating and used for anxiety.
Best of luck to you.
Maxime
Posted by Tony P on February 7, 2008, at 16:05:48
In reply to Re: ssri's and anxiety, posted by Maxime on February 7, 2008, at 14:39:46
> Hi John
>
> Anxiety is awful. SSRIs can help, but in your case it doesn't look like it. Most people get tired on Luvox.
>
> Seroquel might be good for your anxiety.The tricyclic anti depressant Clomipramine use to be the gold-standard for OCD before the SSRIs came along. Maybe that would help.
>
> If you want to try another SSRI go for Lexapro as it is sedating and used for anxiety.
>
> Best of luck to you.
>
> MaximeI too sympathize. I can't take most SSRI's as I get anxiety-related side-effects plus a fairly predicatble anxiety attack with OCD components about noon or mid afternoon -- just when I need to be most productive.
I agree that Lexapro (Cipralex/Escitaprolam) is the best bet for low side effects. I tried Paxil (sweats and shakes), Effexor (supposed to be good for social anxiety!) and was crazy-anxious after a month or so on a fairly low dose, and Celexa gave me extreme anxiety to the point of an out-of-body experience!
I was reluctant to try Lexapro after my experience with Celexa (which is like impure Lexapro, forgive me for oversimplifying). However my pdoc persuaded me that the isomer of Celexa left out in Lexapro was responsible for 90% of the side-effects and 10% of the anti-depressant effect. Turned out it wasn't just manufactuirer's hype, he was right. I was OK on Lexapro at 10 mg/day, essentially zero side effects, but at 20mg/day I started having these anxiety/agoraphobia/OCD attacks around mid-day again. Clonazepam helped a lot but my tolerance is very high so I was having to take 4-6 mg/day, which most Drs don't like prescribing long-term.
BTW, I'm currently taking Remeron 30 mg/day, Requip (ropinirole), a DA agonist which seems to be a good AD adjuvant, Clonazepam 2 mg/day and recently selegeline (oral not EMSAM) 10 mg/day. The latter plus a cup of espresso gives me good mood-brightening and energy, but the daytime anxiety is back!
I'm beginning to think the mid-day anxiety attacks are part of my natural daily cycle and have a huge behavioural component (I obsess about feeling anxious, don't want to leave my apartment, so I feel guilty about not doing chores or missing appointments, so my anxiety goes up even further until I "freeze", get into compulsive reading or computer game-playing and (sometimes literally) pull the bedclothes up over my head!I'll be seeing a new pdoc next month and I would be willing to give Lexapro another try, but not any of the other SSRI's or SNRI's without a lot of persuasion and/or a good supply of a benzodiazepine to fall back on. The Clomipramine is a good suggestion, too, I was just looking at that on the web a few nights ago, it looked helpful enough that I was tempted to try it on my own while I wait for the pdoc appointment, but I'm already messing around with my own medication too much for safety, so I'll wait for his opinion.
Meanwhile, I'm also seeing a cognitive-emotive counselor whom I've know for many years, and I want to work with him on behavioural ways to cope with what's now clearly a very general pattern for me regardless of what meds I'm on.
Good luck and let us know how it goes,
Tony
Posted by Phillipa on February 7, 2008, at 16:31:44
In reply to Re: ssri's and anxiety, posted by Tony P on February 7, 2008, at 16:05:48
Tony could the caffeine be causing the afternoon anxiety? Just a thought. So lexapro is good for anxiety? I take luvox it has no side effects for me but take valium too. Anyway good luck to both of you. Phillipa
Posted by johnj on February 7, 2008, at 16:53:32
In reply to Re: ssri's and anxiety, posted by Tony P on February 7, 2008, at 16:05:48
Tony,
Why didn't you stay on 10 mg of lexapro or augment it with something?
I am not sure what to do as I obssess about searching meds on the net etc., and I need to stop it. I am pretty much a "pure o" but I am starting to think my hypochondrisis and constant search for a "cure" is my compulsion. It has been questioned if I am biplor but it is hard because I have anxiety for sure, and ocd type stuff.
I can't take seroquel as it messed with my sleep and I awoke every hour and it caused severe agitation on 50 mg.
Anafranil may be something I can try but I have a terrible fear of meds. I am afraid if it doesn't work I won't have anything to try, and I will lose hope.
I am more awake at night and only sleep a few hours and feel ok but by morning. I fee bad in the day and am tired the whole day until evening when I rebound. My anxiety is to the point I am numb due to ocd. This is terrible as my body clock is out of whack.
Posted by johnj on February 7, 2008, at 16:58:36
In reply to Re: ssri's and anxiety, posted by Maxime on February 7, 2008, at 14:39:46
seroquel caused akathisia in me. anafranil may be my last chance but I am scared. I may ask my doctor about lexapro too. I pray it would be sedating and help my sleep.
thank you.
johnj
Posted by Tony P on February 7, 2008, at 17:14:55
In reply to Re: ssri's and anxiety » Tony P, posted by Phillipa on February 7, 2008, at 16:31:44
> Tony could the caffeine be causing the afternoon anxiety? Just a thought. So lexapro is good for anxiety? I take luvox it has no side effects for me but take valium too. Anyway good luck to both of you. Phillipa
Yes, the caffeine contributes to the anxiety! It's a two-edged sword for sure, I have to be careful to limit my coffee to one or two cups. But without it the depression/lethargy/hypersomnia tends to take over and I wind up sleeping &/or reading all day, missing appointments & other engagements, which has really negative consequences for my self-esteem and outlook (and others' view of my reliability!) So it's a balancing act.
Thanks,
Tony
Posted by Tony P on February 7, 2008, at 17:31:06
In reply to Re: ssri's and anxiety » Maxime, posted by johnj on February 7, 2008, at 16:58:36
> seroquel caused akathisia in me. anafranil may be my last chance but I am scared. I may ask my doctor about lexapro too. I pray it would be sedating and help my sleep.
>
> thank you.
>
> johnjI found Lexapro was sedating only briefly, for a couple of hours and for the first week or so. It's generally recommended you take it in the morning as it can often cause insomnia. If it helps anxiety, I believe it's because it energizes one to get active and ignore the shaky feeling.
Re seroquel & akathisia, I had that too, also with Remeron amd Trazadone -- very nasty side-effect. Ask your Dr. about adding Requip (ropinirole), it works for me. It is now officially prescribed for Restless Leg Syndrome, which I think is just a variety of akathisia, and I find it usually very effective (.5 mg to 4 mg - there's a regime of titrating the dose up until it works). As a side-benefit, Requip is also (off-label) being testd as an AD adjuvant - it boosts dopamine, which can enhance mood, interest and activity level. It's been working both ways for me for a year now.
I have sleep probelms too. Remeron helped for a while then mostly pooped out. The best thing I have found for sleep is an old TCA - trimipramine. It gives a very natural-feeling sleep and has the added benefit of a mild A-D effect at low doses. Its one drawback is a very long half-life (up to 36 hrs.), which can mean oversleeping & hangover. When I take it, and have to be somewhere the next day, I set two alarms and (if I remember) put the coffee on automatic! (Phillipa - that's another reason for the coffee!!!). I take 50-200 mg, usually 100 mg, about an hour before bed, about one night in three or four.
Tony
Posted by Maxime on February 7, 2008, at 17:36:18
In reply to Re: ssri's and anxiety » Maxime, posted by johnj on February 7, 2008, at 16:58:36
Too bad about the Seroquel. Sometimes I feel like a Seroquel pusher because it really saved my life in the fall.
Why are you scared of anafranil? Is it because it's a tricyclic? It is one of the least toxic ones.
Most people get very tired on Lexapro, and hopefully you will fall into that category.
Keep us posted.
Maxime
Posted by Molybdenum on February 7, 2008, at 18:28:50
In reply to ssri's and anxiety, posted by johnj on February 7, 2008, at 14:09:50
Remeron (mirtazapine) is supposed to have sedation as a side-effect. So for me, it's good to take it at 8pm & it really helps me get to sleep & stay asleep (at least for a few hrs). That might be appropriate for you re the anxiety.
The sedative effects are more pronounced in the lower doses (15mg?) supposedly but I am on 225mg & it still helps me to sleep.
Maybe your doc could give you a short course of Xanax until the mirtazapine kicks in too.
I take Effexor XR (venlafaxine) + mirtazapine. Effexor definitely made me anxious until my body got used to it (a couple of weeks). Then every time we increased the dose to get to what helped my depression, I got anxious again for a couple of weeks.
Mirtazapine & careful use of Xanax helped me through the anxiety. Even just knowing I have a bottle of Xanax now helps me through anxious periods, 'cos I know relief is only a pill away. So I usually end up NOT having to take it at all.
Does that make me crazy? Maybe this would work for you / maybe I'm just a nut - but hey, aren't we at www.fruitcake.com...?
Good Luck :)
Posted by zatar on February 7, 2008, at 20:10:24
In reply to ssri's and anxiety, posted by johnj on February 7, 2008, at 14:09:50
I have the same problem with SSRIs - cannot tolerate side effects. I'd consider Remeron for anxiety/panic attacks, except for the weight gain issue, though that occurs usually at lower doses:Mirtazapine is great for SSRI side effects.
http://www.dr-bob.org/babble/20040210/msgs/312794.htmlPharmacogenetics of antidepressant medication intolerance.
http://www.ncbi.nlm.nih.gov/pubmed/14514498Serotonin transporter polymorphisms and side effects in antidepressant therapy--a pilot study.
http://www.ncbi.nlm.nih.gov/pubmed/16515395?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum- zatar
Posted by johnj on February 7, 2008, at 20:18:28
In reply to Re: ssri's and anxiety » johnj, posted by Tony P on February 7, 2008, at 17:31:06
Tony:
Thank you for your replies it is what I really needed. I have been thinking of doxepin or trimipramine for sleep. Have you ever tried doxepin? I wish I could over sleep! I have tried two doses of 100 mg of neurontin and it is not making me feel very well, acutally more down. Another med bites the dust!
I was on remeron for 3 years and although it helped me sleep I couldn't shake the stomach tension and chest tension it would cause. I just put up with it. It was very hard to come off of. I tried it a second time out of desperation and I did even worse the second time. I believe it really made my ocd worse and made me a big *ss too. The remeron rage was scary.
Do you have any ocd with your anxiety? How did you titrate up on lexapro. I might have to do that. Do you take the requip because of lexapro causing jitterness? Thanks
johnj
Posted by johnj on February 7, 2008, at 20:28:48
In reply to Re: ssri's and anxiety » johnj, posted by Maxime on February 7, 2008, at 17:36:18
Maxine:
I am med sensitive and the ocd makes me so fearful. I know rationally I should try new meds but it is so hard. I have been on two days of neurontin and that is enough.
I had luck with pamelor/lithium/tranzene for 10 years and then ocd went haywire. Didn't know at the time it was ocd but I struggled with remeron (made ocd worse, but helped me sleep) for 3 years.
I am off everything right now due to sensitivities but am struggling. I may have to try the lexapro, very slowly. If it makes me tired enought to sleep I would be thrilled. I just need good sleep and then the ship may right itself.
My fear is also that if something doesn't work then what will I do? I know this is dumb but I think it nevertheless.
johnj
Posted by johnj on February 7, 2008, at 20:30:33
In reply to Re: ssri's and anxiety, posted by Molybdenum on February 7, 2008, at 18:28:50
Thank you but have been on remeron. Made the ocd worse and made me kind of a jerk. Just ask my wife. Last time it made me anxious.
johnj
Posted by johnj on February 7, 2008, at 20:34:39
In reply to Re: ssri's and anxiety - mirtazapine, posted by zatar on February 7, 2008, at 20:10:24
The last time on remeron I was very agitated in the chest and stomach. It would not go away. I was also very angry and combatitive.
Do you have any idea why? Does this mean there are certain drugs I should avoid? Thank you.
johnj
Posted by Racer on February 7, 2008, at 21:35:57
In reply to Re: ssri's and anxiety » Maxime, posted by johnj on February 7, 2008, at 20:28:48
>
>
> I am med sensitive and the ocd makes me so fearful. I know rationally I should try new meds but it is so hard.Believe me, I understand that one. I've had to deal with that a lot myself, so maybe what I have to say will help -- or not, but I'll give it a try. ;-)
First of all, as far as the fear that there's nothing else to try goes, there are a number of things that crossed my mind right away -- Cymbalta, EMSAM, desipramine, Buspar, Risperdal, etc. Those are just the first few that struck me. So, if you try something now, and it doesn't work, there are still a lot of other options that might help.
Now, the hardest part of the Medication Go Round is that it takes some time to know if something will help or not. For many of these medications, the adjustment phase is when the worst of the side effects happen -- which is sort of like a sick cosmic joke on us, since that means we get side effects without benefits during the time we have to figure out whether the medication is going to help us in the end. It's too bad they can't just do a blood test to figure out if it's going to help or not, but they can't, so we have to find ways to cope with the start up ickies.
Here are some of the ways I have dealt with the start up problems:
Discuss it all with my therapist every week until I'm sick of the subject.
Arrange weekly or biweekly check in emails with my psychopharmacologist.
When I started Cymbalta for the first time, a friend of mine called me every day to remind me that it wasn't going to poison me.
I make deals with myself: "Stick it out for this time period, and if it's still a problem, you can stop it." I remind myself frequently that if I don't give it a fair try, I'll never know if it would have helped, and might miss out on the medication that works best for me. I might miss out on relief from my psychiatric disorders *because* of my psychiatric disorders! That's the hardest part, though, because at the same time I'm saying that to myself, another little internal voice is saying, "but it's going to be terrible, it's worse than the disorder it's supposed to treat, etc." Countering that voice is the hardest part for me.
SSRIs do cause a fair number of problems in the first few weeks. Most of those problems go away after anywhere from four to eight weeks, after which they're often quite good for anxiety. It might be worth your while to give Lexapro a good, solid try.
Also, sometimes one drug is good, and helps fix the problem you're taking it for, but it causes another problem. Like EMSAM, which is supposed to be very good for depression and anxiety, but causes insomnia. In those cases, if the medication is working well for whatever you're taking it for, it's often worthwhile to continue it, and add something to fix the problem. In the case of sleep, have you tried Rozerem? It's supposed to improve sleep quality over time, which might be more helpful to you than the alternatives.
Good luck.
Posted by rskontos on February 7, 2008, at 22:02:05
In reply to Re: ssri's and anxiety » johnj, posted by Racer on February 7, 2008, at 21:35:57
John J,
I took lexapro for anxiety and it did a nice job for me. I am not currently on it because it made me too sleepy. I went on 10 mg. to start I believe. Or was it 5. Lexapro now in the beginning does make you more anxious until you get it up to dosage, or your system used to it. My doc warned me. My p doc gave me xanax to cover me. My neuro gave me nothing. (pdoc are better at this part). But knowing it would get worse made it more bearable. it lasted about a week maybe 10days. Then I was ok. Lexapro was too sedating for me. And I mean too sedating. I slept all the time. Like 10-12 hours at a time. But I wasn't anxious.
Anyway, someone mentioned cymbalta, it did nothing for anxiety. It is not great for that I think at least for mine and I have pretty bad anxiety. Anyway, my two cents. good luck,
rsk
Posted by Molybdenum on February 8, 2008, at 4:16:50
In reply to Re: ssri's and anxiety » Molybdenum, posted by johnj on February 7, 2008, at 20:30:33
> Thank you but have been on remeron. Made the ocd worse and made me kind of a jerk. Just ask my wife. Last time it made me anxious.
>
> johnjI don't know if this is an option for you at the moment John, but if it is, think about going somewhere like this that's near you: http://www.byron-bay.com/images/beach.JPG
It helped me a lot when I decided to wean myself off citalopram. New scenery, relaxed & friendly people around, warm, sun - I'm sure it helped me a lot. Maybe this could work for you?
All the Best :)
P.S. Be thankful you still have a wife. Mine decided that my illness was my problem. ;)
Posted by Molybdenum on February 8, 2008, at 4:48:13
In reply to Re: ssri's and anxiety » johnj, posted by Racer on February 7, 2008, at 21:35:57
> It's too bad they can't just do a blood test to figure out if it's going to help or not, but they can't, so we have to find ways to cope with the start up ickies.
>Actually, this recent article at Medscape suggests there might be such a test one day....
http://www.medscape.com/viewarticle/569270?src=mp
"Gene Variants Can Predict the Effectiveness of Antidepressant Treatments"
...not this week though ;)
Posted by johnj on February 8, 2008, at 9:12:46
In reply to Re: ssri's and anxiety, posted by rskontos on February 7, 2008, at 22:02:05
I can't take benzo's as the rebound anxiety and sedation is just too great (xanax and klonopin) Klonopin made me depressed and the xanax rebound was horrible. And then when it wears off I have anxiety for 3 hours. I feel like I am floating and not connected at all. The only one I was on was tranzene but after time it made me depressed. It was hell to get off of too.
I wonder if a super low dose and gradually working up would be best of lexapro?
I didn't take neurontin last night and woke up after about 4.5 hours. I then got up (2:30 am) and then went and put on a meditation tape and laid on the floor and went into REM after about an hour. I woke up again and went back to bed and fell into REM again. IF I get some REM I feel at least in tune with the world. If not I am out of it all day. Very strange. I think a sleep study is in order again while I am on no meds.
I know I only tried neurontin for two days but I could barely function yesterday and I lost a pair of shoes somewhere between work and the gym! I couldn't remember anything on that drug and it was a tiny dose of 100 mg, simply doesn't make sense at all. I asked instructions at the front desk at the gym for a meditation class and couldn't comprhend the directions. The lady looked at me like I was stupid as hell.
johnj
Posted by bissie66 on February 8, 2008, at 12:37:08
In reply to Re: ssri's and anxiety » Tony P, posted by johnj on February 7, 2008, at 16:53:32
> Tony,
>
> Why didn't you stay on 10 mg of lexapro or augment it with something?
>
> I am not sure what to do as I obssess about searching meds on the net etc., and I need to stop it. I am pretty much a "pure o" but I am starting to think my hypochondrisis and constant search for a "cure" is my compulsion. It has been questioned if I am biplor but it is hard because I have anxiety for sure, and ocd type stuff.
>
> I can't take seroquel as it messed with my sleep and I awoke every hour and it caused severe agitation on 50 mg.
>
> Anafranil may be something I can try but I have a terrible fear of meds. I am afraid if it doesn't work I won't have anything to try, and I will lose hope.
>
> I am more awake at night and only sleep a few hours and feel ok but by morning. I fee bad in the day and am tired the whole day until evening when I rebound. My anxiety is to the point I am numb due to ocd. This is terrible as my body clock is out of whack.I don't know if anyone has mentioned this, but a light box really helped me reset my body clock. Now I have normal sleep hours.
Posted by johnj on February 8, 2008, at 13:38:37
In reply to Re: ssri's and anxiety » johnj, posted by bissie66 on February 8, 2008, at 12:37:08
It is like I am wide awake in the middle of the night and I usually am very warm. When I cool down is when I seem to be able to fall back asleep.
Can you please tell me how you did it? What times and how long do you use the light box? Do you make sure you are in the dark earlier in hte evening? Does one have to use a light box or are there other bulbs I can use in a normal lamp?
Thanks
johnj
Posted by Molybdenum on February 8, 2008, at 18:27:46
In reply to Re: ssri's and anxiety » bissie66, posted by johnj on February 8, 2008, at 13:38:37
> It is like I am wide awake in the middle of the night and I usually am very warm. When I cool down is when I seem to be able to fall back asleep.
>You might want to try Melatonin to reset your body clock. I used to not fall asleep until at least midnight, no matter how early I got up the next day. 2 x 3mg slow release tabs at 6pm helps me feel sleepy by 9pm.
Melatonin is pretty cheap too. www.melatonin.com is where I get mine.
:)
Posted by Phillipa on February 8, 2008, at 19:40:03
In reply to Re: ssri's and anxiety » bissie66, posted by johnj on February 8, 2008, at 13:38:37
Same thing happens to me wake up in a sweat and when oool can sleep again? Wonder what causes this? Phillipa
Posted by Tony P on February 9, 2008, at 3:18:17
In reply to Re: ssri's and anxiety » Tony P, posted by johnj on February 7, 2008, at 20:18:28
> Tony:
>
> Thank you for your replies it is what I really needed. I have been thinking of doxepin or trimipramine for sleep. Have you ever tried doxepin? I wish I could over sleep! I have tried two doses of 100 mg of neurontin and it is not making me feel very well, acutally more down. Another med bites the dust!
>
> I was on remeron for 3 years and although it helped me sleep I couldn't shake the stomach tension and chest tension it would cause. I just put up with it. It was very hard to come off of. I tried it a second time out of desperation and I did even worse the second time. I believe it really made my ocd worse and made me a big *ss too. The remeron rage was scary.
>
> Do you have any ocd with your anxiety? How did you titrate up on lexapro. I might have to do that. Do you take the requip because of lexapro causing jitterness? Thanks
>
> johnj
I tried doxepin many years ago and although it is said to be similar to trimipramine I found it frighteningly powerful -- much stronger than say, Elavil, and much, much stronger as an A/D than trimipramine -- although that may have just been where I was at at the time, or my own idiosyncrasy to it. I spent about a week unable to get out of bed because I was so sleepy 24/7, felt somewhat normal/good for about two days, then started to climb the wall with anxiety for the next week. And I was scared to stop taking it, since the sedating effect helped temporarily with the anxiety! In the end I tapered off over a few days. But YMMV, as usual, and many people have used it successfully. I was taking 25 mg t.i.d., a pretty normal starting dose; however, if you're sensitive to the stimulating component of TCA's, as I am, I'd start with just 25 mg at bedtime, none during the day (subject of course to your pdoc's advice), and see how you do.I tried neurontin, just for sleep, taking 2 - 300 mg caps at bedtime. Oddly, although it made me so dopey I had trouble filling out my schedule for the next day half an hour later, it didn't help me _get_ to sleep - I still tossed and turned for an hour or more (my GP nodded and said m-hm when I described this, so my experience apparently is not unusual). But it did _keep_ me asleep -- it stopped me from waking wide-eyed at 4 AM as I had been doing. At that dose, I got a bit of a hangover next morning -- not unpleasant, after a shower and cup or two of coffee I felt quite high and turned into a chatterbox, unusual for me in the morning! I suspect you did not take enough to be effective, the therapeutic range is quite wide, at least 300 to 1800 mg per day, depending how it's used and what for. I took up to 1800 mg/day a few times when I was having pain from a pinched nerve and it helped that quite a lot.
The tension you describe from Remeron - was it just immediately after you took it, or did it develop gradually? The first time I tried it, I had terrible akathisia - I couldn't stay awake & I couldn't sleep for more than a minute without jerking or jumping up. This time around I've been taking it with Requip (.75 mg) and have had no trouble with akathisia at all unless I mix it with other things which can also cause akathisia (e.g. trazadone, seroquel). If the tension you're experiencing is constant, I guess it means it's just too activating for you. I'm taking 2 mg clonazepam most days which no doubt mellows me out a bit!
I don't find the Requip has much effect if any on anxiety or daytime jitteriness; it made me a bit sleepy at first at .75 mg or more (be very cautious if you take it in the daytime until you know how you react - a few people have fallen asleep at the wheel without feeling any warning!), but that passed after a few months. I take it more to avoid the akathisia side-effect, and also as a dopamine mood-enhancer because a small pilot study (Can J. Psych) a couple of years ago showed people taking a wide variety of A/Ds and mood stabilizers showed improvement when Requip was added, no matter what their primary med was. I don't actually _feel_ anything from it directly, but I do believe my mood is better with it than without it. It might help you with the Remeron side-effects around the clock if you divide your dose -- e.g. .5 mg 3x a day, or more if you need it -- it also has a wide therapeutic range, and my 1.5 mg/day total is at the low end.
On the other hand, have you tried Buspar? The tension & rage you describe are something I found Buspar very helpful with years ago - I haven't tried Buspar with Remeron, but I suspect it might make a good combination. Not everybody seems to respond to Buspar, again there's a wide dosage range, from 10 to 60 mg / day -- I usually took 20mg, 10 on a good day, when I was on Serzone.
I definitely have some OCD, not really classic compulsive washing and counting and so on, but I will eat, read &/or or play computer games compulsively -- e.g. I can't stop reading to do anything and as soon as I finish one book I have to pick up another. If I don't retreat into reading I ruminate with lots of negative thoughts and rehearsing imaginary conversations, which again is not quite classic obsession, but close enough for me, and very unpleasant.
I didn't titrate up on the lexapro at all -- just started in at 10 mg every morning for a few months, then upped it to 20 when my depression got worse again. And no trouble stopping it -- I tapered off over about 3 days, but I think I could probably have stopped cold. Not at all like Effexor! I'm not taking it now but I might consider going back to it if my new pdoc wants to push it.
A long answer to your short questions! Good luck,
Tony
Posted by bissie66 on February 9, 2008, at 6:44:58
In reply to Re: ssri's and anxiety » bissie66, posted by johnj on February 8, 2008, at 13:38:37
> It is like I am wide awake in the middle of the night and I usually am very warm. When I cool down is when I seem to be able to fall back asleep.
>
> Can you please tell me how you did it? What times and how long do you use the light box? Do you make sure you are in the dark earlier in hte evening? Does one have to use a light box or are there other bulbs I can use in a normal lamp?
>
> Thanks
>
> johnjThere was a really good thread about this recently - in Jan. I think - I posted a question about light boxes bc my pdoc kept telling me to get one. I got an Apollo golite from Amazon (got great customer reviews). Apollo has a website where you can take a test which will tell you about your circadian rhythms. Anyway the manual tells you when to use it and everything and you can adjust inensity. I use it 30 minutes every morning (or most mornings i should say) while at the computer before work. I'm finding I fall asleep easier, still wake up in the middle of the night, but fall back asleep, and wake up at 6 without an alarm and get up easily (unusual for me). I go to bed at 10 (unusual for me). My pdoc says this sleep cycle is ideal for depression. These light boxes are supposed to help with mood although I've been in a depression that I'm still not out of -- this is probably helping though -- since it is helping with sleep.
My pdoc said do not just buy the light bulb bc they are not intense enough. I recommend you check out that thread. If you search for light box and look for the thread just last month you should find it. Lots of people here seem to use them.
Oh yeah, and my manual says you are supposed to use them with the lights on, and def. in the morning.
Good luck.
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