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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Mtom on May 20, 2018, at 10:08:44
I've read many articles that state it is common to feel worse for a while after starting AD's. However all vaguely state different amounts of time.
Some say the first week or 2, some say the first "few" weeks.
I've been on very low dose Citalopram 2 weeks, 5 mg due to past experiences with AD hypersensitivity. There is evidence I am a slow metabolizer. The plan was to titrate the dose up as I could tolerate, which I have not yet done. I'm pretty sure I'm feeling gradually worse, although I had been feeling increasingly worse for a while before starting. Depression & anxiety being most problematic.
Nothing I can find says precisely how long to wait this out.
My Doctor & I chose Citalopram for my depression and anxiety because it is widely reputed to be the "gentlest" AD for side effects. I know it is not FDA approved for anxiety, but it is reported to be widely prescribed off-label in the U.S. and Canada (where I live) for anxiety as well as depression. Citalopram is approved in many European countries for anxiety as well as depression.
I took a generic version the first 10 days then switched to the name brand Celexa 5 days ago. Could this change have made an impact? I have experienced a few bouts of a new symptom - diarrhea - only since switching to the name brand (this is listed as a "common" side effect).
If, as reputed, this is the "gentlest" AD, I don't know if I have any other options. Had poor experience with amitriptyline with an earlier depression many years ago, some years later a terrible hypresensitivity to Zoloft. Tried Naturopathic supplements for a while without success - even 5HTP induced increased anxiety. Omega 3's and Turmeric did nothing.
Tried very low dose Trazodone for sleep issues for a couple months a year ago, Doctor insisted dose much too low for side effects but I had them anyway - increased anxiety, tinnitus, gastrointestinal, dizziness, etc. Spent the last of the 2 months weaning off slowly (ending with minuscule amounts) to be safe but felt side effects for a long time after anyway.
If it is possible that I need another week or 2 on Celexa for the side effects to dissipate, I will try to wait it out. But how long?
Posted by SLS on May 20, 2018, at 13:22:24
In reply to How long can feeling worse on AD's last til better, posted by Mtom on May 20, 2018, at 10:08:44
I have not read anything that suggests that someone on an antidepressant will feel worse early in treatment using an antidepressant and later go on to respond favorably to it. Providing some sources regarding this would be helpful. On the other hand, the danger of suicide must be considered during the second and third weeks of treatment. It is suggested that this is actually the result of a small improvement in the depressive biology of the disease rather than a worsening of it. As one experiences the beginning of improvement, they gain mental energy. This occurs before there is an improvement in mood and morbid thinking. Sometimes, this energy allows someone to act on their negative thoughts and attempt to take their own life. Personally, I have never felt significantly worse early in treatment and gone on to feel better. That's just me, though.
- Scott
Posted by Mtom on May 20, 2018, at 16:32:57
In reply to Re: How long can feeling worse on AD's last til better, posted by SLS on May 20, 2018, at 13:22:24
Thank you for responding SLS. I have read literally dozens of articles and reports on this, it will take me some time to re-find them all. Here are some off the top (I can post more later):
Activation is a common side effect of the SSRIs and can cause more nervousness, anxiety and irritability, which are the symptoms that the SSRI was meant to treat in the first place! This activation side effect only lasts a few days or a few weeks, and then it dissipates. Dr. Carlo Carandang, Psychiatrist, who is on the Faculty of a major Medical School and main contributor to Anxiety boss.
From Mayo Clinic Website: Managing the Adverse Effects of Antidepressants
Antidepressants can cause unpleasant side effects. For many people, these improve within weeks of starting an antidepressant. The website goes on to list a variety of SEs including:
Agitation, restlessness, anxiety:
Agitation, restlessness or anxiety can result from the stimulating effect of certain antidepressants. Consider these strategies: Get regular exercise.....Practice deep-breathing exercises, muscle relaxation or yogaConsult your doctor about temporarily taking a relaxing or sedating medication or switching to an antidepressant that isn't as stimulating.From WebMD: Some (side effects), like jitteriness, weird dreams, dry mouth, and diarrhea typically go away after a week or two.
Sarah T. Melton, PharmD
Associate Professor of Pharmacy Practice, Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee
The first-line treatment for depression and anxiety disorders is often a selective serotonin reuptake inhibitor (SSRI) or serotonin/norepinephrine reuptake inhibitor (SNRI). Therapy with SSRIs or SNRIs can take up to 4 weeks for efficacy to be apparent and may make anxiety worse before improvement of symptoms is seen.from HealthTalk.org: During the first few weeks' people commonly experience some side effects or feel worse before they begin to feel better. Although the newer Selective serotonin reuptake inhibitors (SSRIs) usually have fewer or less severe side effects than tricyclic antidepressants, various side effects can occur with them all. The doctor will typically prescribe a low dose at the start and this can help to reduce the risk or intensity of side effects. It may take a while to find the right dose.
From Psychiatric Times, Managing the Adverse Effects of Antidepressants
Pascal Sienaert, MD, PhD
Jitteriness syndromeJitteriness is a poorly defined syndrome of early worsening of anxiety, agitation, and irritability. It is estimated to occur in up to 65% of patients immediately after starting therapy with a serotonergic or noradrenergic antidepressant.4 Its importance lies in the fact that it might cause patients to discontinue treatment if they become convinced that it will worsen their condition. A slower titration, especially in patients with anxiety symptoms, might prevent the syndrome. Since jitteriness is time-limited, waiting for tolerance to develop or temporarily combining the antidepressant with a benzodiazepine or propranolol may be helpful.
> I have not read anything that suggests that someone on an antidepressant will feel worse early in treatment using an antidepressant and later go on to respond favorably to it. Providing some sources regarding this would be helpful. On the other hand, the danger of suicide must be considered during the second and third weeks of treatment. It is suggested that this is actually the result of a small improvement in the depressive biology of the disease rather than a worsening of it. As one experiences the beginning of improvement, they gain mental energy. This occurs before there is an improvement in mood and morbid thinking. Sometimes, this energy allows someone to act on their negative thoughts and attempt to take their own life. Personally, I have never felt significantly worse early in treatment and gone on to feel better. That's just me, though.
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> - Scott
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Posted by Phillipa on May 20, 2018, at 17:36:55
In reply to Re: How long can feeling worse on AD's last til better, posted by Mtom on May 20, 2018, at 16:32:57
I have read the same and was always on benzos seemed the ad's make me worse especially prozac when new on the market. I feel my problem has always just been anxiety. Phillipa
Posted by SLS on May 20, 2018, at 20:27:55
In reply to Re: How long can feeling worse on AD's last til better, posted by Mtom on May 20, 2018, at 16:32:57
Thanks for the information. In retrospect, I can see how this can happen. I forgot about the startup anxiety. I guess I was focusing more on depressed mood.
Thanks again.
- Scott
Posted by Christ_empowered on May 21, 2018, at 7:55:21
In reply to How long can feeling worse on AD's last til better, posted by Mtom on May 20, 2018, at 10:08:44
maybe antidepressants just aren't for you? xanax has been used with some success in treating highly anxious depressives. not ideal, but...there is now an xr form, which I would think would make dosing and possibly tapering easier.
there's also a number of stimulants available. ritalin was once very popular for some people with depression, so were the various amphetamines. provigil and nuvigil have been used in some people with good results, and those drugs are far less addictive than the old school stimulants. i seem to recall reading that some shrinks used Tenuate way back when, but I don't know if that's even still on the market.
other than that...I suppose some sort of 'atypical' tranquilizer might help, but I'd personally avoid tranquilizers -if- one can. they can be helpful, but they carry very serious risks throughout treatment, from day 1.
Posted by Mtom on May 21, 2018, at 12:39:45
In reply to Re: How long can feeling worse on AD's last til better » Mtom, posted by SLS on May 20, 2018, at 20:27:55
My depression seems somewhat worse too, but that might be because of the added burden of the start-up anxiety/jitteriness (and the AD not yet kicking in).
In any event, as previously noted, lots of websites mention feeling worse initially (and I have found some more since my last post), but are vague or contradictory on how long this lasts. Some say you have to give the AD time to reach steady state and kick in. Some postulate that this initial "activation" syndrome may be why many patients discontinue AD's very early.
Wish it was better characterized, but post-marketing studies are limited, small samples, often compare only 2 AD's, or 1 AD vs placebo. I read 78% of all studies are funded by the Pharma companies and several post-marketing papers by other researchers say Pharma results often do not reflect what is seen in Clinical Practice, including down-playing of side-effects.
> Thanks for the information. In retrospect, I can see how this can happen. I forgot about the startup anxiety. I guess I was focusing more on depressed mood.
>
> Thanks again.
>
>
> - Scott
Posted by Christ_empowered on May 21, 2018, at 12:55:04
In reply to Re: How long can feeling worse on AD's last til better, posted by Mtom on May 21, 2018, at 12:39:45
i hate to say it, but data quality in psych research is often low quality. seriously. check out the various cochrane reviews on psych issues. they routinely choose to exclude lots of data from analysis because of low quality.
antidepressants are best for severe depression. even then, there's some debate about how effective they are, and there -are- definite risks and adverse effects. there's also the developing concept of "tardive dysphoria" to consider....long term antidepressant use may make things worse, at least for some people.
i wouldn't deal with what you're dealing with right now, personally. ive never taken a psych drug that started out rough and turned out awesome. if anything, things just got worse, in different (and unexpected) ways.
hope you find something you can tolerate that helps.
Posted by bleauberry on May 22, 2018, at 14:45:52
In reply to How long can feeling worse on AD's last til better, posted by Mtom on May 20, 2018, at 10:08:44
Your story sounds eerily similar to mine.
You are overly sensitive. You are made worse instead of better.
My journey was the hell that you described of your own journey.
20 years later I found out it was all longterm undiagnosed Lyme not psychiatric. It only appeared psychiatric.
I did tons and tons of meds and got worse on most of them. Same thing with herbs. And super sensitive. I needed tiny doses and many times could never raise them higher..
My Lyme doctor said that most lyme patients have sensitivities and that many of them do not get better on antidepressants (think treatment-resistant). One of my docs favored Llexapro. He started patients with 1 drop of liquid Lexapro which is only 1/10th of 1mg. So the sensitivity thing and lyme thing are definitely correlated.
Over 20 years I did not get better on meds given to me for psychiatric issues. Each new one was the same nightmare of feeling worse, as you described.
I got almost completely better when I found an LLMD (Lyme Literate M.D. - a few in each state). My recovery came from antibiotics not antidepressants. And it was a true real recovery, not a fake bandaid recovery.
Some will claim that you have to feel worse before you feel better on antidepressants. I personally call that a myth. These drugs should not make anybody feel worse ever, especially with depression patients! Oh my.
They've done testing of antidepressants with normal healthy people. They describe the feeling and as "dysphoric", which basically means bad.
There are studies that suggest that an early favorable response to a med - like within hours or days - is a good indicator that it will be a good med for longer term. The opposite is also suggested, that if it starts bad, it probably doesn't have a great ending.
There are plenty of mysteries and myths. Each of us has to do the best we can with our own journey. My journey taught me that most of us have a treatable disease where the depression is just a symptom of that disease, and that disease is very commonly unsuspected Lyme disease.
The doctors who healed my 20 year treatment resistant depression were emphatic when they claimed that 9 of 10 new patients, poorly managed psychiatric symptoms from other doctors, these folks get well at a rate of 9 out 10 with anti-microbial treatment instead of anti-depression treatment.
Infections seriously mess up the brain. The mood center is a prime target. Psychiatrists are generally poorly trained on this. Family doctors are likewise weak. Testing is pathetic. You simply have to have a really super good doctor who has a reputation of healing a lot of people from impossible situations (LLMDS do that all the time).
> I've read many articles that state it is common to feel worse for a while after starting AD's. However all vaguely state different amounts of time.
>
> Some say the first week or 2, some say the first "few" weeks.
>
> I've been on very low dose Citalopram 2 weeks, 5 mg due to past experiences with AD hypersensitivity. There is evidence I am a slow metabolizer. The plan was to titrate the dose up as I could tolerate, which I have not yet done. I'm pretty sure I'm feeling gradually worse, although I had been feeling increasingly worse for a while before starting. Depression & anxiety being most problematic.
>
> Nothing I can find says precisely how long to wait this out.
>
> My Doctor & I chose Citalopram for my depression and anxiety because it is widely reputed to be the "gentlest" AD for side effects. I know it is not FDA approved for anxiety, but it is reported to be widely prescribed off-label in the U.S. and Canada (where I live) for anxiety as well as depression. Citalopram is approved in many European countries for anxiety as well as depression.
>
> I took a generic version the first 10 days then switched to the name brand Celexa 5 days ago. Could this change have made an impact? I have experienced a few bouts of a new symptom - diarrhea - only since switching to the name brand (this is listed as a "common" side effect).
>
> If, as reputed, this is the "gentlest" AD, I don't know if I have any other options. Had poor experience with amitriptyline with an earlier depression many years ago, some years later a terrible hypresensitivity to Zoloft. Tried Naturopathic supplements for a while without success - even 5HTP induced increased anxiety. Omega 3's and Turmeric did nothing.
>
> Tried very low dose Trazodone for sleep issues for a couple months a year ago, Doctor insisted dose much too low for side effects but I had them anyway - increased anxiety, tinnitus, gastrointestinal, dizziness, etc. Spent the last of the 2 months weaning off slowly (ending with minuscule amounts) to be safe but felt side effects for a long time after anyway.
>
> If it is possible that I need another week or 2 on Celexa for the side effects to dissipate, I will try to wait it out. But how long?
This is the end of the thread.
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