Question about SSRI's

[Lakme]

So I was on amitriptyline a while ago but stopped it after my gastrointestinal symptoms got worse and because it was giving me strange violent thoughts and messing with my personality. Doc put me on Paxil after I weened off of elavil and I suffered an extremely bad reaction to the Paxil that put me in the hospital. I liked the Paxil because it helped with my DPDR but my only complaint is obviously that I ended up in the hospital the morning after.

My only question would be is, if I try another SSRI through my GP will it have similar side effects since it is also an SSRI. I really don't want to go back on elsvil or any medication for that matter but my anxiety is so bad now that I'm underweight no matter how much i eat, the DPDR is insane and I haven't even been able to watch TV since I started having these symptoms. It's killing me and I need a solution now so I can get back on with my life. Please help.

[panic_down_under]

Doc put me on Paxil after I weened off of elavil and I suffered an extremely bad reaction to the Paxil that put me in the hospital.

How much Paxil did you take and what was the nature of the reaction?

[Lakme]

How much Paxil did you take and what was the nature of the reaction?

20 mg which is the dose I was prescribed. I took half and then the other half 3 hours later as instructed by my doctor.

It usually started with a mild tremor before I went to sleep. Before I went to sleep I noticed my eyelid kept dropping by itself. I woke up around 5 AM and I was having trouble breathing, my muscles tensed up, my eyes were dilated and suddenly the air I was breathing felt very cold. My heart was beating a lot faster than when I get palpitations. I couldn't even talk. I had stroke-like symptoms before I went to the hospital and it took a while for the side effects to subside. ER Doctor told me that it couldn't have been the Paxil or that it was just anxiety, I don't remember, but this only happened when I was taking Paxil. I know because I took it several times because the doctor reassured me and each time this happened. Never with any other medication.

[panic_down_under]

ER Doctor told me that it couldn't have been the Paxil or that it was just anxiety, I don't remember, but this only happened when I was taking Paxil. I know because I took it several times because the doctor reassured me and each time this happened. Never with any other medication.

I also suspect it was mostly anxiety. Initially, SSRIs increase serotonin activity which can significantly heighten anxiety levels. However, within a few weeks the brain responds by reducing serotonin synthesis and expression, in some areas of the brain associated with anxiety to less than half the pretreatment level and the side-effect diminishes. Small doses of one of the benzodiazepines for a couple of week might have helped.

In the short-term you could try mirtazapine (Remeron). While classified as an antidepressant it is really only a powerful antihistamine which acts as a strong sedative. Unfortunately, it is very prone to quit working so isn't a great long-term solution, imho. Also at the higher doses it can be stimulating which may exacerbate anxiety.

For the longer-term you could try the TCAs desipramine (Norpramin), or nortriptyline (Pamelor). Unlike amitriptyline, these are primarily norepinephrine, aka noradrenaline, not serotonin reuptake inhibitors. They are also much less likely to cause constipation and other gut issues than amitriptyline (nortriptyline is the active metabolite of amitriptyline).

Your doctor may prefer to prescribe the newer SNRIs milnacipran (Savella) and levomilnacipran (Fetzima) and they are worth a shot. As with the two TCAs I've recommended, these inhibit norepinephrine reuptake more than they do serotonin. Milnacipran hasn't been approved by the FDA for anxiety/depression, but your doctor should be able to prescribe it off-label. Levomilnacipran has been approved but is still under patent (it is a slight modification of the older milnacipran mainly developed to extend the patent) so may be more expensive.

[Lakme]

I also suspect it was mostly anxiety. Initially, SSRIs increase serotonin activity which can significantly heighten anxiety levels. However, within a few weeks the brain responds by reducing serotonin synthesis and expression, in some areas of the brain associated with anxiety to less than half the pretreatment level and the side-effect diminishes. Small doses of one of the benzodiazepines for a couple of week might have helped.

In the short-term you could try mirtazapine (Remeron). While classified as an antidepressant it is really only a powerful antihistamine which acts as a strong sedative. Unfortunately, it is very prone to quit working so isn't a great long-term solution, imho. Also at the higher doses it can be stimulating which may exacerbate anxiety.

For the longer-term you could try the TCAs desipramine (Norpramin), or nortriptyline (Pamelor). Unlike amitriptyline, these are primarily norepinephrine, aka noradrenaline, not serotonin reuptake inhibitors. They are also much less likely to cause constipation and other gut issues than amitriptyline (nortriptyline is the active metabolite of amitriptyline).

Your doctor may prefer to prescribe the newer SNRIs milnacipran (Savella) and levomilnacipran (Fetzima) and they are worth a shot. As with the two TCAs I've recommended, these inhibit norepinephrine reuptake more than they do serotonin. Milnacipran hasn't been approved by the FDA for anxiety/depression, but your doctor should be able to prescribe it off-label. Levomilnacipran has been approved but is still under patent (it is a slight modification of the older milnacipran mainly developed to extend the patent) so may be more expensive.
I'm highly suspicious that they were serious side effects as they happened while I was asleep, I am however, not against trying other SSRIs. My biggest concern is less the anxiety and more the DPDR. I can't keep myself distracted enough not to elicit the panic attacks and I have visual disturbances that keep me from occupying myself. I think I mentioned in the earlier post but I have a difficult time watching tv and doing other things that I used to enjoy. I am not willing to try Paxil or Elavil again but I am willing to look into other options for medication. Thanks.