Not doing so well with my medication...advice?

[Emphyrio]

Hello,

I am have been on 50mg of fluvoxamine for 6 weeks now (a week at 25) and am still dealing with some pretty nasty side effects. They are:
- clenched jaw
- restlessness and restless legs
- a general feeling of agitation, anxiety and akathisia (inner restlessness)

I know from these symptoms that its a result of the medication rather than any underlying anxiety, so I'm not wanting to increase the dosage as of yet. I'm going to give it a full 12 weeks on 50mg.

However, if things do not work out, then what are my options? I've tried several other medications in the past with limited success.

Fluoxetine - I was on this for the best part of the last decade, not going over around 20mg/day. However, I came off it due an increase in my anxiety and intrusive thoughts around 2 years ago. The intrusive thoughts went away and I felt great shortly after coming off it. I then developed a deep depression, which led me to citalopram.

Citalopram - tried 10mg for six weeks in early 2012. Started feeling really restless/agitated around week 5 mark (incidentally, my depression lifted around this time), so stopped taking them. Unlike fluoxetine, I didn't go back to a deep depression after discontinuing them, but became really anxious and my 'pure O' went through the roof.

Clomipramine 25mg in spring 2012. I lasted 9 days - severe GI disturbances, impotence, cognitive dysfunction and blurred vision that made it impossible to drive.

Back to fluoxetine - 20mg sent my anxiety through the roof - super agitated, restless, loss of libido, and only a slight impact upon my harm OCD thoughts. Tapered down to 5mg by November, but still feel bad. Stopped taking it and felt better for a while, then the depression came back (along with some intrusive thoughts).

Spring 2013 - sertraline 25mg - jaw clenching, severe cognitive impairment and severe visual problems. Lasted 5 weeks before discontinuing as the side effects were not improving at all.

I then thought about trying citalopram again at a low dose (5mg). This actually worked. Was on it for around 4 months - the anxiety and intrusive thoughts went away. However, I developed visual snow which persisted to this day - even though I'm not taking it any more. I also suffered high levels of sedation and cognitive dysfunction, which I was prepared to tolerate for a while as the medication was working well for the anxiety, but in the end it was preventing me from reading or studying.

Escitalopram 2.5mg for three days – felt suicidal.

Back to fluoxetine (5mg) – after around 6 weeks my ‘pure OCD’ thoughts and general anxiety feelings returned with a vengeance.

So that led me to fluvoxamine. I feel that part of my problems have been medication-related and medication withdrawal related, so while I would really like to be medication-free, I know that until I get my life sorted out, with a job and some stability, that I will need antidepressants as a crutch. I tried doing CBT after coming off citalopram in early 2012, but the harm OCD was like a stuck record - it was that bad - and I was sure that I was going to follow through with my urges and permanently harm myself.

Any suggestions? I've heard that possibly venlafaxine or mirtazapine could be possibilities, even used in combination, but I'm not sure of the side effects these meds can bring. My doctor suggested low dose quetiapine but I don't like the idea of taking this as its so sedating.

Like I said I'm going to give the fluvoxamine a bit longer though - I need to give it a chance to work.

[TRISTAN]

Hi I'm on quetiapine at the moment 25 mg and feel really tired all the time and also tried. Venaflaxine with mirtazipime but got no joy but everyone is different so worth a try , I found venaflaxine fueled my anxiety but doctor kept me on it for 3 months right up to 225 mg when I got changed to citalipram 10 mg then 20 mg now 40 mg , it takes time as I'm sure you know but I have to stick with it as can't keep changing

Take care x

[Emphyrio]

Thanks Tristan. Are you on the extended or instant release quetiapine? I may consider some but cut the tablets into half or quarters as I'm really sensitive to medication and am sleeping a lot as it is!

I know what you mean about sticking with meds though. I'm having extreme restlessness and akathisia on my current meds but I know I have to stick things out and provide some stability for the sake of my brain!

[TRISTAN]

I'm on xl and doctor has told me to take 50 mg at night but cut them in half and take 25 mg as work full time and glad I did as would prob be asleep by lunch time , I have tried a few in last 10 months and don't really give them a chance to work as doctor keeps telling me .

Ven was by far the worst for me but every one is different and mirtazipime just made me eat loads and loads .

Only been taking quietipine quetiapine for just over a week now so to early to tell I it is working as body still getting use to it

[teej]

SarahH and hanshan on these forums have positive things to say about pregabalin.

It seems hard to get in the UK because of the cost (my doctor flat out refused to even agree it was licensed for anxiety - it is) but since you've been through so much and tried everything maybe you'll get lucky.

I was also going to say have you tried the old tricyclics but then saw you've tried clomipramine. :weep:

Hope you find some luck. Best thoughts.

[Emphyrio]

Thanks again guys. I did consider pregabalin actually. I figured I could maybe continue on the SSRI for the depression and OCD thoughts whilst taking something else for the physical symptoms I face. At the moment I'm trying to avoid caffeine and alcohol where possible and generally try to improve my physical health. I feel that my baseline of anxiety has risen in the last few years - I just need to figure to get it back down to where it was in the past!