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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by marysharon54paints on August 10, 2008, at 16:29:30
After using Effexor for 6 years for major depression, I successfully weaned myself off with a minimum of side effects. I've been doing really well for two months. Last week I was unable to get a refill on my Lunesta prescription so basically stopped using 2 mg cold turkey. I was prepared for the rebound insomnia but have also developed some anxiety and depression. Can anyone tell me if this could be from the abrupt stoppage of the Lunesta? I appreciate any help you can give me as I don't want to fall into the dark hole again...
Posted by Phillipa on August 10, 2008, at 20:21:59
In reply to Withdrawal from Effexor and Lunesta, posted by marysharon54paints on August 10, 2008, at 16:29:30
Yes I feel it could be are you planning on calling your doc? On any other meds? Phillipa
Posted by marysharon54paints on August 10, 2008, at 21:55:19
In reply to Re: Withdrawal from Effexor and Lunesta » marysharon54paints, posted by Phillipa on August 10, 2008, at 20:21:59
Thanks for your reply! My doctor is upset with me for stopping the Effexor so I'm reluctant to contact him. The only other meds I'm on is .25 Mirapex for restless leg syndrome and 60 mg thyroid.
Posted by Phillipa on August 11, 2008, at 12:55:10
In reply to Re: Withdrawal from Effexor and Lunesta, posted by marysharon54paints on August 10, 2008, at 21:55:19
What type of thyroid med are you taking as most is in mcg? Phillipa
Posted by marysharon54paints on August 11, 2008, at 13:39:11
In reply to Re: Withdrawal from Effexor and Lunesta » marysharon54paints, posted by Phillipa on August 11, 2008, at 12:55:10
I'm taking Armour Thyroid...and again, thanks for weighing in here on all this.
Posted by raisinb on August 11, 2008, at 19:34:27
In reply to Withdrawal from Effexor and Lunesta, posted by marysharon54paints on August 10, 2008, at 16:29:30
I'm not an expert, but I think it's unlikely that your depression is caused by Lunesta withdrawal. I'd be more inclined to think that the depression is returning because you stopped Effexor.
Posted by bleauberry on August 11, 2008, at 20:09:26
In reply to Withdrawal from Effexor and Lunesta, posted by marysharon54paints on August 10, 2008, at 16:29:30
It's hard to say. Lunesta is not likely to be involved, but it could be. As my favorite pdoc told me, in psychiatry anything is possible. He was an old highly experienced guy and has seen it all. Could the brain circuits involved with Lunesta somehow be tied in with the mood circuits? I think they are all interconnected, so it's anyone's guess. I have seen here, rarely, reports of people experiencing better moods or lessened anxiety while using Lunesta for sleep.
In my own experiences, after weaning off an antidepressant, depression/anxiety can return anywhere from 1 week to 3 months later. The drug causes brain adjustments that keep things ok. As the drug is removed, those brain changes can start to undo themselves. But in the same way it took an antidepressant maybe 6 to 12 weeks to work, it could take that long for it to "unwork", if that makes any sense?
Hard to say. Maybe start the Lunesta again and see what happens? Go from there.
Posted by linkadge on August 12, 2008, at 17:40:20
In reply to Re: Withdrawal from Effexor and Lunesta, posted by bleauberry on August 11, 2008, at 20:09:26
Its totally possible that the lunesta withdrawl is involved. If dropping effexor were going to cause depression you think it would have hit by now.
There is a gabaergic model of depression whereby certain depression is alleviated with drugs that enhance gabaergic function. SSRI's indirectly increase gaba function as do tranquilizers.
Anything is possible. The best way to find out is to get some more lunesta and to a rechallenge with this agent to see if the depression goes away.
Linkadge
Posted by marysharon54paints on August 12, 2008, at 18:57:21
In reply to Re: Withdrawal from Effexor and Lunesta, posted by linkadge on August 12, 2008, at 17:40:20
Linkadge, thanks so much for the thoughts! I figured the same thing about the Effexor stoppage: if I'd gone nearly three months with no depression, why did it start again? I've also read that although Lunesta isn't a benzodiazepine, it has created some of the same havoc with our brain chemicals. Therefore when you cease usage, you can have some of the same withdrawal symptoms as a benzodiazepine( I've never used one) which after researching today, fit into what's happening to me. Any thoughts on this?
Posted by linkadge on August 12, 2008, at 19:25:37
In reply to Re: Withdrawal from Effexor and Lunesta, posted by marysharon54paints on August 12, 2008, at 18:57:21
Lunesta is somewhat similar to other tranquilizers in that it increases the activity of the inhibitory neurotransmitter GABA in certain brain regions. Benzodiazapines and alcohol have the same effect.
Zopiclone is a little more selective for certain gaba receptors allowing it to be more effective in inducing sleep.
Sedatives and other anticonvulsants are sometimes used to augment antidepressant agents. In some cases they have antidepressant effect in their own right especially where sleep disturbances, pain disorders, migrane or anxiety are present.
Stopping lunesta abruptly could cause rebound anxiety or insomnia, it may also increase emotional reactivness due to a potential increase in limbic neurotransmission.
If possible, can you restart lunesta and decrease a little more slowly? Somtimes you can split tablets in half or get lower dosages.
A slower withdrawl schedule may result in less depression. If depression persists then you may look into finding a doctor comfortable prescribing it on a more long term basis. Alternatively, a low dose of another anticonvulsant, such as lamotrigine, topomax, or gabapentin may improve depression.
Linkadge
Posted by Phillipa on August 12, 2008, at 20:04:14
In reply to Re: Withdrawal from Effexor and Lunesta, posted by linkadge on August 12, 2008, at 19:25:37
Link why and how does the mood stabalizers help depression? Thanks Phillipa
Posted by linkadge on August 12, 2008, at 20:14:45
In reply to Re: Withdrawal from Effexor and Lunesta » linkadge, posted by Phillipa on August 12, 2008, at 20:04:14
In some depression there is a limbic hyperactivity. In these situations thoughts and emotions can be intense and hard to control. Some people might call it agitated depression, or neurotic depression. Mood stabilizers can cause an overal dampening effect on limbic systems. SSRI's kind of do the same thing by increasing the concentration of serotonin in certain limbic regions. Activation of the 5-ht1a receptors causes an inhibitory effect in limbic regions.
Anticonvulsants don't tend to work well with apathetic depression however. They do not boost motivation.
Linkadge
Posted by marysharon54paints on August 12, 2008, at 20:50:23
In reply to Re: Withdrawal from Effexor and Lunesta, posted by linkadge on August 12, 2008, at 20:14:45
I can't tell you how touched I am to have people respond so quickly and thoughtfully to someone's concerns. And although this doesn't replace the need for a doctor's input, it's nice to have the insights of those who've experienced depression, etc....
Posted by Bob on August 12, 2008, at 23:21:03
In reply to Re: Withdrawal from Effexor and Lunesta, posted by linkadge on August 12, 2008, at 20:14:45
> In some depression there is a limbic hyperactivity. In these situations thoughts and emotions can be intense and hard to control. Some people might call it agitated depression, or neurotic depression. Mood stabilizers can cause an overal dampening effect on limbic systems. SSRI's kind of do the same thing by increasing the concentration of serotonin in certain limbic regions. Activation of the 5-ht1a receptors causes an inhibitory effect in limbic regions.
>
> Anticonvulsants don't tend to work well with apathetic depression however. They do not boost motivation.
>
> Linkadge
>
>
>
>Seems like I have a mixed state type depression. I have a ruminative dysphoric depression with anxiety. Then when I introduce antidepressants and anxiolytics I either get panic and akathisia from the activating drugs, or sink down into apathy, sedation and fatigue from the anxiolytics and mood stabilizers. To me these two states are directly contradictory and I don't see how it can be treated when addressing one just aggravates the other.
Posted by SLS on August 13, 2008, at 5:15:58
In reply to Re: Withdrawal from Effexor and Lunesta » linkadge, posted by Bob on August 12, 2008, at 23:21:03
> > In some depression there is a limbic hyperactivity. In these situations thoughts and emotions can be intense and hard to control. Some people might call it agitated depression, or neurotic depression. Mood stabilizers can cause an overal dampening effect on limbic systems. SSRI's kind of do the same thing by increasing the concentration of serotonin in certain limbic regions. Activation of the 5-ht1a receptors causes an inhibitory effect in limbic regions.
> >
> > Anticonvulsants don't tend to work well with apathetic depression however. They do not boost motivation.
> >
> > Linkadge
> >
> >
> >
> >
>
> Seems like I have a mixed state type depression. I have a ruminative dysphoric depression with anxiety. Then when I introduce antidepressants and anxiolytics I either get panic and akathisia from the activating drugs, or sink down into apathy, sedation and fatigue from the anxiolytics and mood stabilizers. To me these two states are directly contradictory and I don't see how it can be treated when addressing one just aggravates the other.There is such a thing as depression with racing thoughts that is not part of the bipolar spectrum. Is your best time of day morning or evenening? At what age did your mood/anxiety disorder begin?
- Scott
Posted by Bob on August 13, 2008, at 11:14:47
In reply to Re: Withdrawal from Effexor and Lunesta » Bob, posted by SLS on August 13, 2008, at 5:15:58
> > > In some depression there is a limbic hyperactivity. In these situations thoughts and emotions can be intense and hard to control. Some people might call it agitated depression, or neurotic depression. Mood stabilizers can cause an overal dampening effect on limbic systems. SSRI's kind of do the same thing by increasing the concentration of serotonin in certain limbic regions. Activation of the 5-ht1a receptors causes an inhibitory effect in limbic regions.
> > >
> > > Anticonvulsants don't tend to work well with apathetic depression however. They do not boost motivation.
> > >
> > > Linkadge
> > >
> > >
> > >
> > >
> >
> > Seems like I have a mixed state type depression. I have a ruminative dysphoric depression with anxiety. Then when I introduce antidepressants and anxiolytics I either get panic and akathisia from the activating drugs, or sink down into apathy, sedation and fatigue from the anxiolytics and mood stabilizers. To me these two states are directly contradictory and I don't see how it can be treated when addressing one just aggravates the other.
>
> There is such a thing as depression with racing thoughts that is not part of the bipolar spectrum. Is your best time of day morning or evenening? At what age did your mood/anxiety disorder begin?
>
>
> - Scott
I am far, far, far worse in the mornings and midday than the evenings. In retrospect, my disorder started to show itself at about 20 years of age or so. I didn't really start to seek treatment until about 23. It then quickly became very serious, and has just gotten worse over the years.
Posted by B2chica on August 13, 2008, at 12:12:13
In reply to Re: Withdrawal from Effexor and Lunesta » Bob, posted by SLS on August 13, 2008, at 5:15:58
i'm curious about this.
i'm usually fine till about 2.5 hours after i wake up. about 9:00-9:30 then boom i drop like a rock mid day i'm at worst.(10-4) but the suicidal thoughts really happen mostly in the morning between 9 and 2.
but i also take ritalin about 8:00 and i know that helps my mood so i don't know if that's part of why i'm ok early morning or not.i've had depression as long as i remember. my first suicidal thinking/semi act was at 14.
what does this say about my depression? does it mean anything regarding meds?
b2c.
Posted by SLS on August 13, 2008, at 14:56:51
In reply to Re: Withdrawal from Effexor and Lunesta » SLS, posted by Bob on August 13, 2008, at 11:14:47
> > There is such a thing as depression with racing thoughts that is not part of the bipolar spectrum. Is your best time of day morning or evenening? At what age did your mood/anxiety disorder begin?
> I am far, far, far worse in the mornings and midday than the evenings. In retrospect, my disorder started to show itself at about 20 years of age or so. I didn't really start to seek treatment until about 23. It then quickly became very serious, and has just gotten worse over the years.
My knee-jerk reaction is to say that you might be a TCA responder. Have you tried any? You may have the classic endogenous depression for which TCAs are superior.
- Scott
Posted by SLS on August 13, 2008, at 15:10:29
In reply to Re: Withdrawal from Effexor and Lunesta » SLS, posted by B2chica on August 13, 2008, at 12:12:13
> i'm curious about this.
>
> i'm usually fine till about 2.5 hours after i wake up. about 9:00-9:30 then boom i drop like a rock mid day i'm at worst.(10-4) but the suicidal thoughts really happen mostly in the morning between 9 and 2.
> but i also take ritalin about 8:00 and i know that helps my mood so i don't know if that's part of why i'm ok early morning or not.
>
> i've had depression as long as i remember. my first suicidal thinking/semi act was at 14.
>
> what does this say about my depression? does it mean anything regarding meds?Tricyclics have traditionally been thought of as being good to treat the classic endogenous depression. This includes loss of weight, loss of appetite, early morning awakenings, mornings worse than evenings, ruminating, psychomotor retardation, and melancholic thoughts.
As you suggested, it is conceivable that the Ritalin helps moderate the depression first thing in the morning. This makes it difficult to assess the base circadian fluctuations in mood throughout the day. Have you tried one of the long-acting forms of methylphenidate or dosed Ritalin throughout the day?
Remeron might be worth looking into. Like the tricyclics, Remeron boosts noradrenergic (NE) neurotransmission, albeit through a different mechanism.
- Scott
Posted by linkadge on August 13, 2008, at 15:57:08
In reply to Re: Withdrawal from Effexor and Lunesta » B2chica, posted by SLS on August 13, 2008, at 15:10:29
I remember than when I was taking zopiclone, I would wake up in a good mood that lasted most of the day. It was just nice to wake up from a relatively good sleep feeling mildly sedated without a million thoughts in my mind. I felt more of a buffer during the day, like my thoughts weren't attacking me. It allowed me to have more moments where I felt ok. I could just sit and enjoy the moment more.
When I get really depressed and anxious I start to leave my body. I start to travel into scarry places that my mind creates that are so detached from the world around me. I respond to very little, I can't hear, see, or feel what is going on around me. I am just locked in that world of fear and uncertainty. I become helpless because I don't know who I am. I can't get back to who I am. Sometimes, the slightest amount of stress puts a big thick plank between who I currently am and who I am as a whole.
For me, anything can can ground me and pull me back into the world around me usually helps my depression. Most of the SSRIs worsen that state and make me feel even more detached. I don't need something to push me more away from myself than I already am. I need something that can just bring me back to myself just enough so that I can say, "oh yeah, thats who I am", so that I can remember the reasons why I am doing what I am doing.
methyphenidate or atomoxetine can be grounding and can help me stay in my body in the presence of adversity. They keep my brain from pulling out too far and locking me in those hellish places. *Certain* sedatives and benzodiazapines can also really help my mood. A low dose of lorazepam, oxepam, or zopiclone can help ground me.
I can't take them chronically in high doses as this usually abolishes the best coping strategies.
Its about helping me get back into the zone, I guess. Not a place of being high, just a place where I can feel ok for long enough to let my brain rest and redirect myself. Sometimes just a nudge here and there can go a long way.
Linkadge
Posted by Phillipa on August 13, 2008, at 20:11:10
In reply to Re: Withdrawal from Effexor and Lunesta » Bob, posted by SLS on August 13, 2008, at 14:56:51
Scott mine started as panic attacks age 24 no depression til thyroid as you know so what meds for me as nights are always better feel like dying when wake-up and get up late. Stay up late also. Phillipa
Posted by Phillipa on August 13, 2008, at 20:14:58
In reply to Re: Some personal experiences, posted by linkadge on August 13, 2008, at 15:57:08
Used to be the same for me but now getting tolerant to valium think switching to the xanax during the day too as was supposed to do would work or would I be tolerant to them also. Great to have two of the best minds to me you and Scott here. Phillipa
Posted by Bob on August 13, 2008, at 22:50:50
In reply to Re: Withdrawal from Effexor and Lunesta » Bob, posted by SLS on August 13, 2008, at 14:56:51
> > > There is such a thing as depression with racing thoughts that is not part of the bipolar spectrum. Is your best time of day morning or evenening? At what age did your mood/anxiety disorder begin?
>
>
> > I am far, far, far worse in the mornings and midday than the evenings. In retrospect, my disorder started to show itself at about 20 years of age or so. I didn't really start to seek treatment until about 23. It then quickly became very serious, and has just gotten worse over the years.
>
>
> My knee-jerk reaction is to say that you might be a TCA responder. Have you tried any? You may have the classic endogenous depression for which TCAs are superior.
>
>
> - Scott
One of the first meds I ever took was Anafranil. It was brutal from a side effects standpoint. I gained 50lbs right quick. The whole experience is fading from memory now since it was in the early nineties, but I remember being very unhappy about the anticholinergic effects also.I've thought about the Zoloft/Nortriptyline deal before, but then it seems like I'll have the worst of both the SSRIs and the TCA's.
Posted by SLS on August 14, 2008, at 4:52:47
In reply to Re: Withdrawal from Effexor and Lunesta » SLS, posted by Bob on August 13, 2008, at 22:50:50
> > > > There is such a thing as depression with racing thoughts that is not part of the bipolar spectrum. Is your best time of day morning or evenening? At what age did your mood/anxiety disorder begin?
> > > I am far, far, far worse in the mornings and midday than the evenings. In retrospect, my disorder started to show itself at about 20 years of age or so. I didn't really start to seek treatment until about 23. It then quickly became very serious, and has just gotten worse over the years.
> > My knee-jerk reaction is to say that you might be a TCA responder. Have you tried any? You may have the classic endogenous depression for which TCAs are superior.
> One of the first meds I ever took was Anafranil. It was brutal from a side effects standpoint. I gained 50lbs right quick. The whole experience is fading from memory now since it was in the early nineties, but I remember being very unhappy about the anticholinergic effects also.
>
> I've thought about the Zoloft/Nortriptyline deal before, but then it seems like I'll have the worst of both the SSRIs and the TCA's.Nortriptyline is much milder than Anafranil. In fact, the longer you are taking it, the less pronounced are the side effects. I barely know that I am taking it.
- Scott
Posted by Bob on August 14, 2008, at 11:31:52
In reply to Re: Withdrawal from Effexor and Lunesta » Bob, posted by SLS on August 14, 2008, at 4:52:47
> > > > > There is such a thing as depression with racing thoughts that is not part of the bipolar spectrum. Is your best time of day morning or evenening? At what age did your mood/anxiety disorder begin?
>
> > > > I am far, far, far worse in the mornings and midday than the evenings. In retrospect, my disorder started to show itself at about 20 years of age or so. I didn't really start to seek treatment until about 23. It then quickly became very serious, and has just gotten worse over the years.
>
> > > My knee-jerk reaction is to say that you might be a TCA responder. Have you tried any? You may have the classic endogenous depression for which TCAs are superior.
>
> > One of the first meds I ever took was Anafranil. It was brutal from a side effects standpoint. I gained 50lbs right quick. The whole experience is fading from memory now since it was in the early nineties, but I remember being very unhappy about the anticholinergic effects also.
> >
> > I've thought about the Zoloft/Nortriptyline deal before, but then it seems like I'll have the worst of both the SSRIs and the TCA's.
>
> Nortriptyline is much milder than Anafranil. In fact, the longer you are taking it, the less pronounced are the side effects. I barely know that I am taking it.
>
>
> - Scott
>I'm somewhat worried about the urinary hesitancy, as I've had some problems with that in the past. Also, I'm currently on Celexa and wonder if it would be worth it to cross taper to Zoloft so that I have that combo, or maybe just stay with the Celexa. I tend to wonder about the theories of Zoloft having that slight dopamine effect and whether that has any truth to it.
- Bob
This is the end of the thread.
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