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Dr. Bob is Robert Hsiung, MD,
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Posted by phillipa on October 17, 2012, at 12:31:03
In reply to Anxiety HELP!!!, posted by ChicagoKat on October 17, 2012, at 12:15:51
Kat personally I agree about anxiety. And I do anything to eliminate anxiety. Once that is done then take it from there. So I said what I'd do. Sometimes I don't give a hoot what others think or even a doc. As they don't live in my skin. Please feel better and keep posting. Love Phillipa
Posted by rjlockhart37 on October 17, 2012, at 13:41:39
In reply to Anxiety HELP!!!, posted by ChicagoKat on October 17, 2012, at 12:15:51
two options....a GABAgeric med such has Depekote, Gabitril...or Nuerontin, there all have mood stabilizing properties, gabatril im not sure completly. They reduce anxiety not as much as benzos but are favored because of less addiction and withdraw properties.
2nd a beta blocker
-would definetly be a offlabel solution for this anxiety due to exess NE...it will defiently bring relief because it blocks NE and adrenaline... I have no idea if you would look to this option and doc because its less traditional than regular anxiety meds. Propranolol is a widely known in use...yet it has side effects on respitory by depressing it. Another with less side effects is metoprolol....its selective which propranolol is not.Nortriptyline i researched, its a NRI but its a bit confusing because it does effect serotonin but it clearly stated in sources that it provides sedation, then another says its activating, but the anxiety your having is from the NE reptake.
Antipsychotics are a less suited for this situation but they can provide relief lowering nuerotransmitter levels, but can vary well cause depression to come. Seroquel and Zyprexa are good for anxiety but mental impairment is known.
Those are options i researched, of course theirs traditional benzos for this which are effective.
Keep me updated.
r
Posted by enndub on October 17, 2012, at 14:36:22
In reply to Anxiety HELP!!!, posted by ChicagoKat on October 17, 2012, at 12:15:51
Hello Kat, sorry to hear about your anxiety.
How long have you been on Nardil at the higher dosages that cause ataxia? Is it possible that this is just transient side effect that will go away in time? If so, it might be worth trying to deal with the ataxia for a couple months or tapering up more slowly to try to avoid side effects while being able to take a full therapeutic dose of Nardil.
I never had anything more than minimal balance issues, but I did have severe tremor to the point where I was shuffling around like a parkinson's patient for a couple weeks. Tremor is often associated with ataxia and for me that side-effect went away very slowly over the course of three months.
Also, you may be able to find a med to treat the coordination side-effects. Amantadine, Buspar, and Mirapex are some possibilities that come to mind.
Hope you feel better,
Nick
Posted by ChicagoKat on October 17, 2012, at 16:06:07
In reply to Re: Anxiety HELP!!! » ChicagoKat, posted by phillipa on October 17, 2012, at 12:31:03
> Kat personally I agree about anxiety. And I do anything to eliminate anxiety. Once that is done then take it from there. So I said what I'd do. Sometimes I don't give a hoot what others think or even a doc. As they don't live in my skin. Please feel better and keep posting. Love Phillipa
Hi Phillipa, thanks as always for being so darn caring and supportive. I know I'll beat this, with everyone's support here on PB.
Kat
Posted by gilmourr on October 17, 2012, at 16:08:57
In reply to Re: Anxiety HELP!!! » phillipa, posted by ChicagoKat on October 17, 2012, at 16:06:07
How long have you been on the nortryptiline? I love getting increases in anxiety when I start meds because that usually means it dies down like 20-30 days in for me. Usually produces good results.
If you've just started the nortryptiline I would no way come off of it. Give it time if you've only been on it a week.
Posted by ChicagoKat on October 17, 2012, at 16:10:55
In reply to Re: Anxiety HELP!!!, posted by rjlockhart37 on October 17, 2012, at 13:41:39
Hi rj,
Thanks for answering my call for help...it means so much that everyone is so supportive.Your ideas were good ones, but I am already on Neurontin...and going through it rather fast, I'm afraid. I build up rapid tolerance to it for some reason. But it is a godsend, given that benzos are out.
I am also already on metoprolol. It does help with the physical sensations of anxiety, and it also helps with my BP which has been continuing to rise, in conjunction with the increase in my anxiety.
As far as APs, there are definitely out. One, I'm not sure if they mix well with MAOIs or not. I'd do more research on that, but the fact is, I will never go back on one, b/c they all cause agitation and one caused akathisia in me.
But thanks again for your suggestions. They are much appreciated. I hope you are well.
Kat> two options....a GABAgeric med such has Depekote, Gabitril...or Nuerontin, there all have mood stabilizing properties, gabatril im not sure completly. They reduce anxiety not as much as benzos but are favored because of less addiction and withdraw properties.
>
> 2nd a beta blocker
> -would definetly be a offlabel solution for this anxiety due to exess NE...it will defiently bring relief because it blocks NE and adrenaline... I have no idea if you would look to this option and doc because its less traditional than regular anxiety meds. Propranolol is a widely known in use...yet it has side effects on respitory by depressing it. Another with less side effects is metoprolol....its selective which propranolol is not.
>
> Nortriptyline i researched, its a NRI but its a bit confusing because it does effect serotonin but it clearly stated in sources that it provides sedation, then another says its activating, but the anxiety your having is from the NE reptake.
>
> Antipsychotics are a less suited for this situation but they can provide relief lowering nuerotransmitter levels, but can vary well cause depression to come. Seroquel and Zyprexa are good for anxiety but mental impairment is known.
>
> Those are options i researched, of course theirs traditional benzos for this which are effective.
>
> Keep me updated.
>
> r
Posted by ChicagoKat on October 17, 2012, at 16:19:36
In reply to Re: Anxiety HELP!!! » ChicagoKat, posted by enndub on October 17, 2012, at 14:36:22
Hi Nick,
It was my first try on Nardil during which I had the ataxia and had several falls. I was at a dose of 60mg/day. I am now on a dose of 45mg/day, which is considered sub-therapeutic. When I was on the 60mg/day, I did achieve a remission in my depression before the ataxia started. But, when I had the ataxia, my pdoc stopped the med. We had other options to try at the time. Now there are none left.So given all this, I'm actually tempted to increase my Nardil dose to 60mg/day until I achieve remission, and then lower it to 45mg/day right away. All while monitoring my gait (it's the first thing to go before I suffer falls...it's like a warning sign) I've read the manufacturer's info, and they actually say that once remission is reached, the dose should be decreased to a dose of 15mg/day as a maintenance dose. So I figure if I can achieve remission safely at 60mg/day and then back off to 45mg/day I might be OK. I have extra Nardil, so I could do this. But I know my pdoc would NOT approve, he's too worried of falls, which I understand. But at this point I'm honestly less afraid of falling than the possibility of feeling sh*tty for the rest of my life.
Anyways, thanks for posting and offering advice. It's advice I'm most tempted to take.
How are you faring these days?
My best,
Kat
> Hello Kat, sorry to hear about your anxiety.
>
> How long have you been on Nardil at the higher dosages that cause ataxia? Is it possible that this is just transient side effect that will go away in time? If so, it might be worth trying to deal with the ataxia for a couple months or tapering up more slowly to try to avoid side effects while being able to take a full therapeutic dose of Nardil.
>
> I never had anything more than minimal balance issues, but I did have severe tremor to the point where I was shuffling around like a parkinson's patient for a couple weeks. Tremor is often associated with ataxia and for me that side-effect went away very slowly over the course of three months.
>
> Also, you may be able to find a med to treat the coordination side-effects. Amantadine, Buspar, and Mirapex are some possibilities that come to mind.
>
> Hope you feel better,
> Nick
Posted by ChicagoKat on October 17, 2012, at 16:23:12
In reply to Re: Anxiety HELP!!!, posted by gilmourr on October 17, 2012, at 16:08:57
> How long have you been on the nortryptiline? I love getting increases in anxiety when I start meds because that usually means it dies down like 20-30 days in for me. Usually produces good results.
>
> If you've just started the nortryptiline I would no way come off of it. Give it time if you've only been on it a week.Good points gilmourr, thanks. but i'll never understand loving getting anxiety from a med. i just hate anxiety SO much.
How are things for you these days? I know you're suffering your own battle with Nardil
Kat
Posted by ChicagoKat on October 17, 2012, at 16:30:40
In reply to Re: Anxiety HELP!!! » gilmourr, posted by ChicagoKat on October 17, 2012, at 16:23:12
Posted by jono_in_adelaide on October 17, 2012, at 18:03:02
In reply to Anxiety HELP!!!, posted by ChicagoKat on October 17, 2012, at 12:15:51
Well, I guess your 2 options are stop the nortriptyline and hope that the Nardil is able to pull it off, persevere with the nortriptyline + nardil and hope the side effects abate, or take the nardil + nortriptyline with somthing for anxiety.....my suggestions would be either Atarax 50mg tid (soft approach) or Geodon 20mg bid (headiver approach)
God, if I was a doc I'd be handing out pills like elvises physician wouldnt I..... hi Dr Nick!
Posted by gilmourr on October 17, 2012, at 18:17:38
In reply to Re: Anxiety HELP!!! » gilmourr, posted by ChicagoKat on October 17, 2012, at 16:23:12
> > How long have you been on the nortryptiline? I love getting increases in anxiety when I start meds because that usually means it dies down like 20-30 days in for me. Usually produces good results.
> >
> > If you've just started the nortryptiline I would no way come off of it. Give it time if you've only been on it a week.
>
> Good points gilmourr, thanks. but i'll never understand loving getting anxiety from a med. i just hate anxiety SO much.
>
> How are things for you these days? I know you're suffering your own battle with Nardil
> Kat
>
>It'll be fine, I'm going to ween off of it in 7-8 days, take 2 weeks to let it clear my system and restart. I will never understand why coming from 60 mg back to 45 mg doesn't work, but after 38 days of waiting...
Maybe I just needed to go down to 30 mg instead of wait a bit longer at 45 mg, but I know that if I go to 0 and restart it that it's very certain that I will get that 70% remission feeling. Then I can add nortryptiline and finally get that combo off my mind :)
Next two week are going to suck though :( There go my plans for partying with friends on halloween.
Posted by ChicagoKat on October 17, 2012, at 20:06:51
In reply to Re: Anxiety HELP!!!, posted by jono_in_adelaide on October 17, 2012, at 18:03:02
> Well, I guess your 2 options are stop the nortriptyline and hope that the Nardil is able to pull it off, persevere with the nortriptyline + nardil and hope the side effects abate, or take the nardil + nortriptyline with somthing for anxiety.....my suggestions would be either Atarax 50mg tid (soft approach) or Geodon 20mg bid (headiver approach)
>
> God, if I was a doc I'd be handing out pills like elvises physician wouldnt I..... hi Dr Nick!LOL Dr Nick!!! I've decided what I'm gonna do...I'm upping my Nardil to 60mg/day, a dose which from experience I know puts my depression and anxiety in remission. But it also causes ataxia after I've been on it for a while. So I'm gonna wait til I've achieved remission, then go back down to 45mg/day. Even the package insert for Nardil says that for dosing to use 60-90mg/day until remission is achieved, then after that they say to go to a maintenance dose of 15mg/day! My guess is that once you've got all the enzymes inhibited, only a small maintenance dose is required to keep them at that state. Besides, a drug company would not recommend such a thing if it hadn't been proved to work...they stand to lose more money if people lower their doses.
Anyways, that's my plan. b/c I just can't stand anxiety, it is worse than depression. oh, I do have neurontin for the anxiety, but I go through it pretty quickly; for some reason I build up tolerance to it at a fast rate.
Thanks for your suggestions Dr. Nick!!!
My best,
Kat
Posted by ChicagoKat on October 17, 2012, at 20:09:10
In reply to Re: Anxiety HELP!!!, posted by gilmourr on October 17, 2012, at 18:17:38
>
> It'll be fine, I'm going to ween off of it in 7-8 days, take 2 weeks to let it clear my system and restart. I will never understand why coming from 60 mg back to 45 mg doesn't work, but after 38 days of waiting...
>
> Maybe I just needed to go down to 30 mg instead of wait a bit longer at 45 mg, but I know that if I go to 0 and restart it that it's very certain that I will get that 70% remission feeling. Then I can add nortryptiline and finally get that combo off my mind :)
>
> Next two week are going to suck though :( There go my plans for partying with friends on halloween.Well gilmourr, I hope your plan works! And good luck with the withdrawal and washout...I know it's gonna be rough for you, but hang in there!
Kat
Posted by enndub on October 18, 2012, at 11:07:33
In reply to Re: Anxiety HELP!!! » enndub, posted by ChicagoKat on October 17, 2012, at 16:19:36
Kat, I've been doing much better these past few days, thanks for asking.
I haven't had a bad day since I started taking my entire 75 mg dose at bedtime, and it really does help with the daytime fatigue. The first few days were good, but these past few days have been even better, so I'm hoping that my previous high is my new low and I have reached a new peak on the Nardil mountain.
It hasn't really been long enough to say for sure, but I'm optimistic. I'm over four months in already (almost 8 weeks on 75 mg) so it seems like the Nardil can just slowly slowly slowly improve after the initial blip and crash.
Hope you're feeling alright today, I'm optimistic for both of us.
Nick
Posted by ChicagoKat on October 18, 2012, at 13:05:11
In reply to Re: Anxiety HELP!!!, posted by enndub on October 18, 2012, at 11:07:33
Hi Nick,
I'm so glad to hear you are doing better. I'm happy for you, and it also gives me hope for me.
I've decided to call what Nardil does when you start it 'the blip and then the dip'. I know I have to be patient for things to slowly get better now that I am in the dip. But one good sign is that even though I've come down from the blip, I'm still feeling nowhere near as bad as I was before I started Nardil. :)
My greatest hope is that we both continue to improve. Thanks so much for your support, my Nardil Buddy. :)
Kat
> Kat, I've been doing much better these past few days, thanks for asking.
>
> I haven't had a bad day since I started taking my entire 75 mg dose at bedtime, and it really does help with the daytime fatigue. The first few days were good, but these past few days have been even better, so I'm hoping that my previous high is my new low and I have reached a new peak on the Nardil mountain.
>
> It hasn't really been long enough to say for sure, but I'm optimistic. I'm over four months in already (almost 8 weeks on 75 mg) so it seems like the Nardil can just slowly slowly slowly improve after the initial blip and crash.
>
> Hope you're feeling alright today, I'm optimistic for both of us.
>
> Nick
Posted by ChicagoKat on October 18, 2012, at 13:48:39
In reply to Re: Anxiety HELP!!! » jono_in_adelaide, posted by ChicagoKat on October 17, 2012, at 20:06:51
Update: thanks to Dr Nick's (Jono's) excellent suggestions, I have decided to continue my Nortriptyline, and I am using gabapentin to fight the anxiety...so far it is working. But I did also up my dose of Nardil to 60mg/day, and I'm being extra cautious and observant of my gait and will immediately go back to 45mg/day if I notice a problem, and spend the rest of that day in bed where I won't be at risk for a fall. The ataxia problem leaves pretty quickly when I decrease the dose, and the change in my gait is a good warning sign before I experience any falls.
So, with this combo of meds, I am very optimistic that I will achieve remission. My thanks to enndub and to Jono!!
Kat> > Well, I guess your 2 options are stop the nortriptyline and hope that the Nardil is able to pull it off, persevere with the nortriptyline + nardil and hope the side effects abate, or take the nardil + nortriptyline with somthing for anxiety.....my suggestions would be either Atarax 50mg tid (soft approach) or Geodon 20mg bid (headiver approach)
> >
> > God, if I was a doc I'd be handing out pills like elvises physician wouldnt I..... hi Dr Nick!
>
> LOL Dr Nick!!! I've decided what I'm gonna do...I'm upping my Nardil to 60mg/day, a dose which from experience I know puts my depression and anxiety in remission. But it also causes ataxia after I've been on it for a while. So I'm gonna wait til I've achieved remission, then go back down to 45mg/day. Even the package insert for Nardil says that for dosing to use 60-90mg/day until remission is achieved, then after that they say to go to a maintenance dose of 15mg/day! My guess is that once you've got all the enzymes inhibited, only a small maintenance dose is required to keep them at that state. Besides, a drug company would not recommend such a thing if it hadn't been proved to work...they stand to lose more money if people lower their doses.
>
> Anyways, that's my plan. b/c I just can't stand anxiety, it is worse than depression. oh, I do have neurontin for the anxiety, but I go through it pretty quickly; for some reason I build up tolerance to it at a fast rate.
>
> Thanks for your suggestions Dr. Nick!!!
> My best,
> Kat
>
>
Posted by schleprock on October 19, 2012, at 16:34:43
In reply to Anxiety HELP!!!, posted by ChicagoKat on October 17, 2012, at 12:15:51
I would eliminate all those caffeinated beverages you probably drink (soda, esp. tea and coffee!) Maybe avoid chocolate for awhile, as well as spicy foods.
Posted by ChicagoKat on October 19, 2012, at 20:25:55
In reply to Re: Anxiety HELP!!!, posted by schleprock on October 19, 2012, at 16:34:43
> I would eliminate all those caffeinated beverages you probably drink (soda, esp. tea and coffee!) Maybe avoid chocolate for awhile, as well as spicy foods.
Good advice schleprock. I have cut back on my diet coke and it is helping. plus, I have some Neurontin that really helps when it gets bad. Thanks so much for posting with some good advice :)
Kat
Posted by phidippus on October 20, 2012, at 17:18:50
In reply to Anxiety HELP!!!, posted by ChicagoKat on October 17, 2012, at 12:15:51
I would ask your doctor for a benzodiazapine to help you through this period of anxiety. Most antidepressants can cause a period of anxiety within the first couple of weeks of taking them. I'm betting this period will subside in a couple weeks.
Eric
Posted by ChicagoKat on October 20, 2012, at 20:56:53
In reply to Re: Anxiety HELP!!! » ChicagoKat, posted by phidippus on October 20, 2012, at 17:18:50
> I would ask your doctor for a benzodiazapine to help you through this period of anxiety. Most antidepressants can cause a period of anxiety within the first couple of weeks of taking them. I'm betting this period will subside in a couple weeks.
>
> EricThanks so much for the advice Eric. I saw my pdoc a few days ago and told him I was anxious, and sure enough, he being the wonderful pdoc that he is, he gave me both Klonopin and a higher dose of Neurontin. It's all got my anxiety under control. But I hope you are right and that the anxiety does abate; I don't want to have to take these extra meds forever!
How are you doing these days?
Kat
Posted by phidippus on October 20, 2012, at 23:30:43
In reply to Re: Anxiety HELP!!! » phidippus, posted by ChicagoKat on October 20, 2012, at 20:56:53
I'm bored out of my mind! I'm also experiencing a flood of negative thoughts. I don't know if I'm depressed or not. Maybe I'm just frustrated with life. One positive-I've been writing music again, so that helps.
Glad you're getting that anxiety under control...
Eric
Posted by ChicagoKat on October 22, 2012, at 12:34:13
In reply to Re: Anxiety HELP!!! » ChicagoKat, posted by phidippus on October 20, 2012, at 23:30:43
> I'm bored out of my mind! I'm also experiencing a flood of negative thoughts. I don't know if I'm depressed or not. Maybe I'm just frustrated with life. One positive-I've been writing music again, so that helps.
>
> Glad you're getting that anxiety under control...
>
> EricHi Eric,
Sorry you're dealing with frustration, boredom, and negative thoughts. Was the Wellbutrin you were taken replaced my anything else?I can really sympathize you b/c I feel exactly the way you describe feeling...bored out of my mind with a flood of negative thoughts. Can't even read these past couple of days, and reading is a good barometer for my mood. If I can't do even that, then It's for sure I'm feeling like sh*t. When will this f*ck*ng Nardil ever kick in???? People tell me to be patient, well I'm NOT patient, and I never will be. I'm sick to death of feeling like dying.
Do you still have suicidal ideation? If so we should form a club. Sorry I vented on you, I hope you don't mind. And I'm glad that you are writing music again; that must be a positive sign! I didn't know you write music, that is really cool. What kind of music do you write?
OK, thanks for listening to my rant...like I said I hope you didn't mind. And I hope you feel better soon. Here's to BOTH of us feeling better soon!!!!!!!
Kat
Posted by phidippus on October 22, 2012, at 13:36:19
In reply to Re: Anxiety HELP!!! » phidippus, posted by ChicagoKat on October 22, 2012, at 12:34:13
>When will this f*ck*ng Nardil ever kick in????
Well, when did you start taking it?
>Do you still have suicidal ideation?
Every day.
>What kind of music do you write?
http://soundcloud.com/themusicofes
Eric
Posted by ChicagoKat on October 22, 2012, at 16:33:51
In reply to Re: Anxiety HELP!!! » ChicagoKat, posted by phidippus on October 22, 2012, at 13:36:19
> >When will this f*ck*ng Nardil ever kick in????
>
> Well, when did you start taking it?
>
> >Do you still have suicidal ideation?
>
> Every day.
>
> >What kind of music do you write?
>
> http://soundcloud.com/themusicofes
>
> EricI've been on Nardil for 3wks now. I know sometimes it takes longer to work, but thing is, the last time I tried it, it acted much more quickly, like in a week and a half to two weeks or so. My gut tells me this is yet another drug poopout. Of course my gut speaks from my depression. so, sigh, I will give it more time, and feel like hell in the meantime.
I like your music. Instapitta (sp?) sounds exactly the way I feel inside. I will listen to more when I have more time.
I'm sorry you still suffer suicidal ideations. I suffer from them too. You didn't tell me, have you been put on anything else since the wellbutrin had to be stopped?
Kat
Posted by phidippus on October 23, 2012, at 14:05:02
In reply to Re: Anxiety HELP!!! » phidippus, posted by ChicagoKat on October 22, 2012, at 16:33:51
>have you been put on anything else since the wellbutrin had to be stopped?
I have not. I'm eyeing desipramine, though.
Eric
This is the end of the thread.
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