My Hero (Lexapro) is letting me down... What about a Lexapro cocktail?

[panic_down_under]

Sadly, I didn't find Xanax until I was in my 30's... So I went through literally hundreds of panic attacks with nothing...

You were probably lucky you didn't find Xanax (alprazolam) earlier. The benzodiazepines actually worsen anxiety disorders by promoting the loss of brain cells¹ in the hippocampal regions of the brain which is the physical underpinning² of these disorders. The most (self)prescribed anti anxiety drug, alcohol, has the same problem, as does the THC component of cannabis.

How much Xanax are you taking now? It might be why the escitalopram is losing effectiveness. Both antidepressants and the cognitive, behavioural (CBT, REBT) and mindfulness therapies work by stimulating the growth of new hippocampal brain cells which is the reverse of what the Xanax is doing if you're taking it regularly.


[1]

Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)

Nochi R, Kaneko J, Okada N, et al. (2013)
Diazepam treatment blocks the elevation of hippocampal activity and the accelerated proliferation of hippocampal neural stem cells after focal cerebral ischemia in mice.
J Neurosci Res. Nov;91(11):1429-39 (Abstract)

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)

Chen J, Cai F, Cao J, et al. (2009)
Long-term antiepileptic drug administration during early life inhibits hippocampal neurogenesis in the developing brain.
J Neurosci Res. Oct;87(13):2898-907 (Abstract)

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)

Stefovska VG, Uckermann O, Czuczwar M, et al (2008)
Sedative and anticonvulsant drugs suppress postnatal neurogenesis
Ann Neurol. 2008 Oct;64(4):434-45 (Abstract)

See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly.

[2]
(Wayback Machine Archive - original site starts here, but graphics links broken)

Chapter 6: What happens inside people’s brains when they’re depressed?

Chapter 7: Why do some parts of the brain atrophy during major depression?

Chapter 8: What is causing brain atrophy in depression?

Chapter 9: Some good news — anti-shrink molecules!

Chapter 10: All the Players on One Stage

Chapter 11: Can the Shrinkage Be Reversed?

Chapter 12: Putting it all together
Genes, Stress, Depression and Atrophy — Conclusion

[panicface]

Could it be that you are needing to take more alprazolam/xanax to get the desired effect? You appear to be very reliant on xanax. This could be about benzo usage/addiction not lexapro?

No, I only take it with panic - when Lexapro is working, that might be 1mg every two months. When it's not working (like now) it's 0.5mg 3x a week. So, not very much. No tolerance.

[panicface]

You could have more control over your anxiety. I'm not talking about yoga, meditation, or weighted blankets here. Those are all useful, but it's not what I'm talking about. I'm talking about challenging your thoughts and understanding why your body responds the way it does (fight or flight) and creates all of those unpleasant symptoms which ramp up anxiety. (Once you see the whole picture, it's really quite simple)

Nope, not autistic.

I suppose I don't believe that changing my thought patterns can alter my anxiety. This is a beast I've lived with for 35 years, and each time it presents it subtly shifts itself in a way that makes it believable. "Okay, the last 874 panic attacks were nothing, but THIS ONE... is the real one!"

I also fall into the mindset of a child when I get an anxiety attack, I physically cannot recall that I've had this happen before, what treatment I had, and that it finished and I was fine. It's embarrassing actually - but true. I keep a spreadsheet on my computer with dates, symptoms and outcomes - I refer to this when anxious, doesn't really help.

My anxiety normally begins with palpitations. That is a REAL thing, my heart physically skips a beat (or double beats). No matter how much I tell myself it's my brain that's causing this, I can't get passed the fact that it's a physical sensation - my heart stops, my body jolts up in fear, and in comes the wave of anxiety. Yes, I do CBD in that I look at the bigger picture, play games like reframing, or focusing on something else - but when the next palp comes, and the next and the next - all bets are off.

Anyway, you made a great post. Thank you.

I'll look up CBT and see of there are lessons I can practice at home. I just sort of hate my brain, all my life it's done terrible things to me via anxiety. I just don't believe it will ever be on my side, or that I could think thoughts that would tame it. But.. who knows.

Honestly, Lexapro worked like a charm, I'm 50 - perfect scenario would be to find a drug that would tamp down the anxiety for another 10, 20, 30 years - and I'm out of here.

[pulisa]

Your brain is "you" though..You're compartmentalising this and making it into a you versus anxiety scenario..Is it easier for you to see yourself as a victim of something outside your control rather than having the power yourself to manage your own thoughts?

[panicface]

Your brain is "you" though..You're compartmentalising this and making it into a you versus anxiety scenario..Is it easier for you to see yourself as a victim of something outside your control rather than having the power yourself to manage your own thoughts?

Hrm...

Do you really think that's true? I remember the guy that got shot along with Regan, his personality changed 180% afterwards. Plenty of folks suffer strokes and have other neurological changes and their personalties change.

Let's say Brady was a funny guy before the shooting, and after he was a totally serious dude... Who is/was the real Brady? I'd say the guy before the damage was the true personality, and that the damage impaired the machine (brain = chemical machine) that allowed him to communicate etc.

For me, I feel that anxiety is a disease, just like any other that can effect you neurologically, like Alzheimer's etc - something has gone wrong in the brain, nervous systems, endocrine system, gut flora (who knows) and signals for fight & flight are either over-sensitive, sensitive to the wrong stimuli, always on, over-react etc. This is not 'me' - this is a disease.

Put it this way, if you were on the Starship Enterprise - and you went to Dr. Mccoy - would he scan you and say - o wow, I see you're freaking out three times a week, that's normal - back to engine room you... Or would he say, hey - something is going on here, your cortisol is raised, and you're laying on the deck crying every few days - let me fix that chemical imbalance for you.


The idea that everything related to anxiety is environmental in nature (caused from historical experience, or the way you deal / think / react to the world and if you can only find the right toolset to change your thinking, it will go away - seems farcical to me. I have a cousin with Down syndrome, I could sit with him all day and tell him to try to think his way out of that and not too sure it's gonna work.

Sure, finding mental coping mechanisms, looking at whole picture, reframing, clenching, relaxing technics - these can help you deal with anxiety. But in my case (at least) - something from birth was turned on, over-sensitized or whatever - and I am hard wired to freak out and live with anxiety. As someone who seems to have dealt with the same thing I respect it's working for you.

Some things do help me - like biofeedback has taught me to lower my HR, practicing breathing insures I don't hyperventilate, clenching my fists and relaxing them soothes the buildup, looking 'up' lowers HR, mantras help.. But panic attacks (for me) come out of a clear blue sky 99% of the time. I can be watching 'Love Island' and eating some chips happy as clam and next second - my head is on fire... There's no 'me' in that - it's only the disease.

I'm sure oneday there will be a cure for anxiety, once they figure out what gone wrong in the brain or body. I think it's physical not mental. My 5yo self was physically sick, not mentally sick from my environment - was I denied milk, did a dog scare me, did I think the mobile over my crib was falling? Meh.. physical screw up somewhere in body.

My girlfriend is an asian with blue eyes, we've DNA tested her, 100% pure... Mutation happen as a matter of course. I don't think bi-polar, Schizophrenia, malignant narcissism, are conditions that can be cured from 'right thinking'

Peace

[pulisa]

If you see anxiety as a disease then no type of therapy will help you. This is a rigid and entrenched belief of yours.

Anxiety isn't in the same category as serious mental illness such as bi polar and schizophrenia.

Have you ever been assessed for a diagnosis other than GAD/panic disorder/HA?

[NoraB]

Honestly, Lexapro worked like a charm, I'm 50 - perfect scenario would be to find a drug that would tamp down the anxiety for another 10, 20, 30 years - and I'm out of here.

Surely, the 'perfect' scenario would be for you to learn how to challenge your thoughts so much that no medication is required?

I was 47 years old before I understood the stress response and how to challenge my thoughts. It's doable, believe me.

I don't want to push the autism thing, but I am curious with your 'Nope, not autistic' reply.

How do you know you're not autistic? (I didn't know that I was autistic for 43 years)

Because one explanation for your lifelong issues with anxiety would be that you have a neurological difference, such as autism.

If there are any diagnosed members of your family (or people who were/are considered to be 'eccentric') then it may be worth you giving this some consideration? When I was diagnosed, it really helped me to understand why I've always struggled so much. (And why my anxiety has always been set to 'high')

Anyway, I'll just leave this with you. I mentioned it because quite a few things that you mention in your posts suggest autism to me. (Autism, being the varied spectrum that we understand it to be today, and not 'that dude from Rainman')

[pulisa]

I hope that you won't reject this suggestion by Nora as being "ridiculous"..It's certainly worth considering in my opinion.