![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by MissThang on January 2, 2011, at 11:59:17
I'm in the process of washing out from parnate to restart wellbutrin xl. When I washed out from wellbutrin to go on parnate, I felt somewhat anxious, but I was taking Nuvigil each day, which I credited for my anxiety level at that time.
This past week off parnate (especially after about 4 days off of it) I became quite anxious and started having panic attacks for the first time in years. I have some xanax to take, but not very much and it makes me tired anyway (difficult to work when taking it during the day), so I resorted to taking Abilify, which helped my anxiety previously when I was on wellbutrin combined with vyvanse (the vyvanse helped some but made me anxious).
The problem is, on 15mg of abilify, my anxiety is much better, but it makes me "flat" and makes me crave sweets.
So what should I take instead? If I'm in the midst of a panic attack, I won't hesitate to take xanax, but I need something more consistent that works more like the abilify but doesn't make me flat. My plan is to supplement the wellbutrin with SAM-e, since the best result I've ever had was a combination of supplements with wellbutrin (I actually was in remission for 3 whole days!). Problem is, that particular combo stopped working after 3 days, which isn't typical for me (usually either something works within a week or so, or it doesn't work at all for me.) I never tried SAM-e with wellbutrin, though, so I'm really hoping that combo gives me the relief my other combo did, but for much longer.
Any suggestions as to what I should take for this anxiety? In the past, I've done really badly on ssri's (apathetic, just sit around and eat), so I hesitate to try one of those, but I think I'm going to have to be on something for anxiety if I want to resume the wellbutrin and add SAM-e since both of those are known to be activating.
I'd really appreciate any help you can give me.
Posted by Phillipa on January 2, 2011, at 13:01:01
In reply to Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 2, 2011, at 11:59:17
I'm sorry I feel it would take quite a while for an SSRI since you say they work for anxiety for you. Sounds like you are doing the best for now. Emergency call to doc? Phillipa
Posted by MissThang on January 2, 2011, at 16:29:27
In reply to Re: Rebound Anxiety after Parnate...What to take? » MissThang, posted by Phillipa on January 2, 2011, at 13:01:01
Hi Phillipa -- I actually meant that ssri's don't work for me...they just make me lazy, apathetic and fat:-(.
I actually did call my dr. already and he just gave me the go ahead to take 2mg xanax each day instead of 1mg that I usually take just for sleep. That's great and all, but like I said -- the xanax really makes me tired and really, 2mg isn't enough when you're feeling anxious all day and having panic attacks on top of it.
The abilify seems to be doing ok as far as keeping the anxiety mostly at bay, but again, I don't see that as a long term solution because it makes my personality flat and makes me gain weight.
So I'm looking for a good long term solution for the anxiety, and I don't think abilify is it. So I'm looking for good ideas for long term anxiety mgmt.
Posted by medamorphosis on January 3, 2011, at 10:26:45
In reply to Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 2, 2011, at 11:59:17
You can add Wellbutrin to Parnate you know.
Posted by MissThang on January 3, 2011, at 10:41:54
In reply to Re: Rebound Anxiety after Parnate...What to take? » MissThang, posted by medamorphosis on January 3, 2011, at 10:26:45
I know adding wellbutrin to parnate's been done, but with the bad luck I've had with parnate (constantly elevated blood pressure, unusually easily triggered hypertensive events that have actually continued even after I've discontinued parnate), I'm just not brave enough to start wellbutrin even a day prior to the 14-day washout.
I know parnate's been a lifesaver for many, but it was a nightmare for me -- tons of side effects and the only benefit I got was a slight decrease in anxiety, which, as you've read, has come back with a vengence since discontuing the parnate.
No -- with my history with this drug, I think it's best to wait the full 14 days for a washout before I start wellbutrin, and even then, I'm worried about taking it since my blood pressure has remained elevated since stopping the parnate and I know that wellbutrin sometimes causes an increase in bp too.
So...back to my original question -- what's the best thing to take for this very high level of anxiety I've been experiencing since about day 4 of my parnate washout. The abilify's helping, and of course, I have a low dose of xanax I can take if/when panic attacks occur, but I don't want to be on abilify long term because of the side effects (weight gain -- it causes me to crave sweets; and it adds a certain "flatness" to my personality). Any suggestions?
Posted by medamorphosis on January 3, 2011, at 11:16:26
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 3, 2011, at 10:41:54
> I know adding wellbutrin to parnate's been done, but with the bad luck I've had with parnate (constantly elevated blood pressure, unusually easily triggered hypertensive events that have actually continued even after I've discontinued parnate), I'm just not brave enough to start wellbutrin even a day prior to the 14-day washout.
>
> I know parnate's been a lifesaver for many, but it was a nightmare for me -- tons of side effects and the only benefit I got was a slight decrease in anxiety, which, as you've read, has come back with a vengence since discontuing the parnate.
>
> No -- with my history with this drug, I think it's best to wait the full 14 days for a washout before I start wellbutrin, and even then, I'm worried about taking it since my blood pressure has remained elevated since stopping the parnate and I know that wellbutrin sometimes causes an increase in bp too.
>
> So...back to my original question -- what's the best thing to take for this very high level of anxiety I've been experiencing since about day 4 of my parnate washout. The abilify's helping, and of course, I have a low dose of xanax I can take if/when panic attacks occur, but I don't want to be on abilify long term because of the side effects (weight gain -- it causes me to crave sweets; and it adds a certain "flatness" to my personality). Any suggestions?NARDIL
Posted by MissThang on January 3, 2011, at 11:56:17
In reply to Re: Rebound Anxiety after Parnate...What to take? » MissThang, posted by medamorphosis on January 3, 2011, at 11:16:26
You probably haven't read my other post about why I was discontinuing parnate, but there's no way on earth I'm trying another MAOI -- virtually everything in my "normal" diet is off limits because of either yeast extracts or soy derivatives. Most people can have small amounts of these things while on an maoi, but not me, apparently.
Besides, I'm not up for the sexual dysfunction and weight gain from nardil --- they're just not worth it.
All I'm asking for is an anxiety remedy that's good for longer term use that doesn't take up to a month to work -- the abilify isn't a good long term solution for me, but it's all I've got at this point...
Posted by willyeeee on January 3, 2011, at 17:57:47
In reply to Re: Rebound Anxiety after Parnate...What to take? » MissThang, posted by Phillipa on January 2, 2011, at 13:01:01
If you have parnate anxiety the best option for anxiet period is a benzo,prefably ativan or klonopin. fyi mebicar is a non script order online benzo as well.
Posted by MissThang on January 3, 2011, at 19:19:27
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by willyeeee on January 3, 2011, at 17:57:47
Thanks, Willy. I've got some xanax, but I only have enough of it to take when/if a panic attack actually hits -- not enough to take all day. Besides, being addictive (and having had a problem with xanax tolerance in past), it's not really a good long term solution.
Anyone have any suggestions for a long term anti-anxiety med that's pretty benign and not addictive?
Posted by medamorphosis on January 4, 2011, at 3:17:10
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 3, 2011, at 11:56:17
> You probably haven't read my other post about why I was discontinuing parnate, but there's no way on earth I'm trying another MAOI -- virtually everything in my "normal" diet is off limits because of either yeast extracts or soy derivatives. Most people can have small amounts of these things while on an maoi, but not me, apparently.
>
> Besides, I'm not up for the sexual dysfunction and weight gain from nardil --- they're just not worth it.
>
> All I'm asking for is an anxiety remedy that's good for longer term use that doesn't take up to a month to work -- the abilify isn't a good long term solution for me, but it's all I've got at this point...Whats 6 months of side effects if it solves the problem? And Nardil is much less harsher on the mind so it seems. Weight gain is caused by over eating carbs so its up to you to control ur appetite. It enhances GABA so no benzo needed. And sod all the food limits. Same thing goes-continue the problem or give up a few foods?
Was extremely worth it to me. And as for sexual side effects, they GO in the end, unlike many SSRIs and other drugs. Just my thoughts.med
Posted by medamorphosis on January 4, 2011, at 3:20:18
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 3, 2011, at 19:19:27
> Anyone have any suggestions for a long term anti-anxiety med that's pretty benign and not addictive?
I realy think ur asking the (almost) impossible. Nothing benign has that power. If so someone please tell me too!
Posted by MissThang on January 4, 2011, at 8:49:07
In reply to Re: Rebound Anxiety after Parnate...What to take? » MissThang, posted by medamorphosis on January 4, 2011, at 3:17:10
Med -- I'm glad Nardil has been such a great drug for you, but as I've indicated, it's simply not an option for me. I'm not willing to change my entire eating regime, go without sex and look like a pig -- all those things would just make me more depressed.
At least when I'm on Wellbutrin, I can eat whatever I want without gaining weight, have a solid sex life from day 1 and maintain my weight without having to constantly fight cravings. But the main thing is that I had too many hypertensive crisis on parnate to consider an maoi again -- living a life that constricted isn't really living to me.
Hasn't anyone had any luck with buspar or something like that? The abilify is working ok, but again, it makes me crave sweets and it does give me occasional dyskenesia (sp?), which I don't want to become permanent. I also have been told by my therapist that it seems to make me "flat" -- less animated in the way I express myself both verbally and with facial expressions and gestures, and that makes me not who I really am.
I don't think I'm asking for something impossible! There has to be a med that's good for anxiety on a long term basis that doesn't make you gain weight or jerk uncontrollably.
Posted by Phillipa on January 4, 2011, at 19:38:38
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 4, 2011, at 8:49:07
I'd still say a low dose benzo valium or klonopin. No weight gain in my experience. Phillipa
Posted by medamorphosis on January 4, 2011, at 20:42:33
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 4, 2011, at 8:49:07
I still reckon Nardil is a dam good idea. Its TOTALLY different. But if sex and eating what you want is more important than getting better then obviously forget it
med
Posted by Maxime on January 4, 2011, at 23:19:09
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by MissThang on January 4, 2011, at 8:49:07
>
> At least when I'm on Wellbutrin, I can eat whatever I want without gaining weight, have a solid sex life from day 1 and maintain my weight without having to constantly fight cravings. But the main thing is that I had too many hypertensive crisis on parnate to consider an maoi again -- living a life that constricted isn't really living to me.
>
> Hasn't anyone had any luck with buspar or something like that? The abilify is working ok, but again, it makes me crave sweets and it does give me occasional dyskenesia (sp?), which I don't want to become permanent. I also have been told by my therapist that it seems to make me "flat" -- less animated in the way I express myself both verbally and with facial expressions and gestures, and that makes me not who I really am.
>
> I don't think I'm asking for something impossible! There has to be a med that's good for anxiety on a long term basis that doesn't make you gain weight or jerk uncontrollably.If you are looking for something long term as you state in the above post, I would stay away from benzos (not that you mentioned you wanted to take them). A low dose of Elavil might help you. A dose so low that weight gain shouldn't be a problem. What does your doctor think you should try? Seroquel is good for anxiety, but weight gain can happen. Sigh. It's not easy is it?
Posted by Maxime on January 4, 2011, at 23:21:48
In reply to Re: Rebound Anxiety after Parnate...What to take? » MissThang, posted by Phillipa on January 4, 2011, at 19:38:38
Phillipa, she is looking for something *long term* as stated in her posted. I understand that you have had no problems with valium. But for the majority of the people benzos do become dependent on them and then have a hard time coming off.
Posted by MissThang on January 5, 2011, at 0:32:20
In reply to Re: Rebound Anxiety after Parnate...What to take? » Phillipa, posted by Maxime on January 4, 2011, at 23:21:48
Med -- I understand that you like nardil, but maoi's just aren't for everyone. One of the few things I have to feel good about in my life at this point is my appearance and therefore taking that away from me by piling on weight just wouldn't be a good long term solution for me, espcially when you tack on the sexual dysfunction aspect of it. I am in my 40's and have never been married and one of my most important goals in my life is to get married and nardil's side effects would just get in the way of that goal.
Besides -- taking an maoi for anxiety seems like using an elephant gun to kill an gnat to me...not that anxiety isn't horrible, it's just that nardil is primarily used for major depression/social phobia -- not for general anxiety, and I already have a plan in place for the med combo I want to take to address my depression -- wellbutrin combined with SAM-e and if that doesn't work, then I'll try combining wellbutrin with lithium since wellbutrin's been the only AD that's ever worked for me.
Max -- You're right -- long term benzo use isn't a good idea for me. I quickly become tolerant to benzo's and have already developed some tolerance to the xanax I've been taking for the past couple of weeks (no more than 2mg/day), so while I prefer to have some in my medicine cabinet for those times when I have a panic attack, I find it's already become less useful for me in that context because of the tolerance I've already developed.
Elavil's an interesting idea -- I wonder if I just too it at night if it would quell the anxiety the following day?
Posted by mrtook on January 5, 2011, at 14:13:00
In reply to Re: Rebound Anxiety after Parnate...What to take? » MissThang, posted by medamorphosis on January 4, 2011, at 20:42:33
I know in Europe they have approved lyrica (pregablin) for GAD. I have no experience with it just thought I would shout it out as another thing to consider.
Posted by MissThang on January 6, 2011, at 7:36:10
In reply to Re: Rebound Anxiety after Parnate...What to take?, posted by mrtook on January 5, 2011, at 14:13:00
Mrtook -- Interesting that you suggested Lyrica. My father took that for back pain for over a year, and while it did help with his pain, it made him very anxious, so he had to stop taking it. I guess there's no way to know how a specific med with affect any given person.
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.