View Full Version : Up and Down...why?
So I started taking Pregabalin about a week ago. Started at 75mgs/twice a day. I quickly noticed a pretty good anti/anxiety feeling about two hours after the 1st dose. After a couple of days, I noticed my anxiety comes back HARD about 4-6 hours after a dose, so I was told to take 75mgs 3 times a day. I did that for about 4 days and loved the few hours of relief it gave me, but the anxiety still hit hard before it was time to dose again. My doc just upped me to 150mgs/3 times a day, and this has seemed to really help the effects last longer...but not quite to the next dose. I am sleeping great for the 1st time in 4 months, and when the Lyrica effects hit, it is really a nice break from the anxiety, though I am a bit spaced out (maybe kind of high?). Just wondering, will this level out to a more consistant effect on my anxiety? Do I need to dose 4 times a day? (Really expensive to do it this way, not sure if insurance will cover it)? The pregabalin obviously has a positive effect on my anxiety, but the up and down roller coaster is pretty frustrating. Anybody experience this, or can offer some advice?
panic_down_under
24-05-17, 23:08
Do I need to dose 4 times a day? (Really expensive to do it this way, not sure if insurance will cover it).
Welcome to No More Panic, :welcome:
Pregabalin has a short elimination half-life of around 6 hours, however, it can remain effective for a few more hours for some. It appears you may be metabolizing it faster than most.
Welcome to No More Panic, :welcome:
Pregabalin has a short elimination half-life of around 6 hours, however, it can remain effective for a few more hours for some. It appears you may be metabolizing it faster than most.
So will this kind of be my experience with this drug? Is it not likely to level out? I have been really struggling the last 4 months and kinda desperate for something to work. This has been the best so far. Was on Zoloft (50mgs) for 8 years after my first anxiety episode, came off it in October and felt totally fine after about 3 weeks of discontinuation effects. In January had some anxiety creeping back and thought I would be proactive and restart the Zoloft...well it didn't work and made my anxiety crazy high. Tried 6 weeks of Zoloft, didn't kick in, switched to Lexapro for 7 weeks...it never kicked in either. Then started the Pregabalin a week ago and have been very encouraged by the early effects, but the crashes are rough! Hoping this is the answer and I can get back to life.
panic_down_under
25-05-17, 01:33
So will this kind of be my experience with this drug? Is it not likely to level out?
A higher dose may resolve the issue, but there are no guarantees. Pregabalin seems to be one of those meds which work very well for some, but doesn't do much for most.
Was on Zoloft (50mgs) for 8 years after my first anxiety episode, came off it in October and felt totally fine after about 3 weeks of discontinuation effects. In January had some anxiety creeping back and thought I would be proactive and restart the Zoloft...well it didn't work and made my anxiety crazy high. Tried 6 weeks of Zoloft, didn't kick in,
Six weeks if not really long enough to draw any conclusions as antidepressants typically kick-in between 3 to 12 weeks from starting a therapeutic dose. Also 50mg is generally the minimum effective dose with most needing to take 100-150mg for good results and and higher doses are often needed the second time around. The initial side-effects can be more severe and/or different too.
Ok, seems like from reviews I have seen (8.1 for anxiety at drugs.com) and looking at websites, including this one, I have heard this has been one that works for a lot of people. Psych doc really thought this would be a good one to stabilize me. I am hopeful the fact that I can feel it working with every dose, that would be a good thing and it would stabilize. Are you on this drug panic? Anyone else who has taken this drug have any thoughts or a similar experience?
---------- Post added at 19:40 ---------- Previous post was at 19:37 ----------
Six weeks if not really long enough to draw any conclusions as antidepressants typically kick-in between 3 to 12 weeks from starting a therapeutic dose. Also 50mg is generally the minimum effective dose with most needing to take 100-150mg for good results and and higher doses are often needed the second time around. The initial side-effects can be more severe and/or different too.
Hmm, if that is the case, my psych doc wasn't very helpful. No kidding about side effects being more severe, they were almost unbearable. Maybe I should try the Zoloft again with pregabalin as a buffer to help me sleep and help with the increased anxiety of Zoloft.
I have to take issue with the statement: "doesn't do much for most".
I have posted the link to drugs.com once before, where it clearly does much for most, but here it is again:
https://www.drugs.com/comments/pregabalin/for-generalized-anxiety-disorder.html
Evidence?
Hanshan, do you have experience with pregabalin? If so, what are your thoughts on the ups and downs, is this common while starting this med?
I have seven years experience with pregabalin. The ups and downs at first are probably due to the short half-life of around seven hours (though it varies from person to person). However, that's half-life, so some always remains and that can accumulate. Furthermore, some meds get taken up by the body and gradually re-released - this may also be the case for pregabalin. If so, this would help explain evening out over time.
It took me about 3 months on 150mgs Pregabalin before I felt really better. There is unfortunately no quick fixes. I did have some horrible side effects for the first 3 weeks but these gradually disappeared.
I am doing much better now, certainly not back to myself, but better. Currently on 600mgs of Pregabalin, Doctor has prescribed Paxil (Seroxat) to add with the Pregabalin. What are everyone's thoughts? Is this a good combo? The idea would be to use the Pregabalin to help with horrendous SSRI startup effects I have experienced in my recent trials with Zoloft and Lexapro (I didn't get these effects 9 years ago when I first started Zoloft). Then once stable on the Paxil, I would start to wean off the Pregabalin as it is terribly expensive (only wean if possible, I have no problem being on both long-term if I can get back to being myself). Anyone tried this combo or one like it? Any advice or pearls of wisdom before I start the Paxil and take the plunge?
Hi Utah49er - It's good to hear that you are feeling better. I have to say I tried paroxetine some time back, and the initial side effects really were intolerable for me. However, many people take it, so it's clearly a case of how it affects each individual. I switched to mirtazapine, which was a much easier start-up for me.
My pregabalin costs me about A$3.50 (US$4.50) a day for 600 mg (it's not Australian government-subsidised for anxiety, but some of this can be recouped from private health insurance that includes pharmaceuticals). Fortunately, I can afford it and consider it money well spent - about the cost of a bus fare or cup of coffee, which most people wouldn't think twice about paying.
Handshan, thanks for your comments. I actually suggested Mirtazapine to my doc instead of Paxil, it seems it is not used as much here in the states (probably due to its lack of FDA approval for any anxiety disorders, much like pregabalin unfortunately, honestly we are behind the rest of the world in many instances such as these). He wanted to try low dose Paxil 1st, simply due to its FDA indications for all anxiety disorders. Hopefully low dose start of Paxil is better for me than the trials of Zoloft and Lexapro (tolerated Zoloft well during startup 8 years ago, off for 4 months, then sent me for this crazy ride the last 4 months this time). Paxil is supposed to be the least activating of the SSRIs so I am hopeful. I'll keep you posted, unfortunately my Pregabalin is a little more than double your $4 a day, still totally worth it at this point as it seems to be helping, but I have to think I will do well on an SSRI again as I barely thought about anxiety the last 8 years I was on Zoloft.
---------- Post added at 20:43 ---------- Previous post was at 19:32 ----------
Handshan, were you on pregabalin when you tried the paroxotine? If not do you think you could have got through the startups with pregabalin?
No, it was at the start of a very bad anxiety period some years back, and I was given paroxetine - but within a day or so I'd developed nausea, diarrhea, a jaw tremor and anorgasmia - really terrible (I don't want to put you or anyone off it, as many people find it okay). The doctor switched to diazepam, then mirtazapine. The pregabalin was added a year or so later.
It's funny that the pricing for pregabalin should be different, as I assume its the same brand - Lyrica - from Pfizer. Does the US allow you to import either Lyrica or generic pregabalin from a cheaper country?
Handshan,
I just did my 2nd night of Paxil, woke up at 5:15 and couldn't really go back to sleep. I didn't feel any anxiety, which was nice, but I did this early waking for the 3 months I was trying Zoloft and Lexapro and to be honest, I am not wanting to do it again. Thinking of asking for a switch to Mirtazapine. How long after you started Mirtazapine did you start to feel better? I am getting desperate, the Pregabalin has helped a lot, but I don't think I want to do the Paxil trial.
panic_down_under
02-06-17, 22:49
I just did my 2nd night of Paxil, woke up at 5:15 and couldn't really go back to sleep. I didn't feel any anxiety, which was nice, but I did this early waking for the 3 months I was trying Zoloft and Lexapro and to be honest, I am not wanting to do it again. Thinking of asking for a switch to Mirtazapine
How about just adding a small dose of mirtazapine at night to help you sleep. SSRI induced insomnia is a fairly common at the beginning, but it usually does resolve after a while. The mirtazapine may also slightly speed up Paxil kick-in too.
Panic, I didn't know you could take Mirtazapine and Paxil together, isn't there a risk of serotonin syndrome? I have never taken a "cocktail" of meds, only psych med I have ever taken before 4 months ago was the Zoloft I took for years, so being already on 600MGs of Lyrica, and now 10mgs of Paxil...I guess I am scared to add yet ANOTHER drug to the mix. I don't want to be someone who needs a whole mouthful of meds to function, as that has never been the case. Though your advice is probably sound, I guess I am just scared, but I have anxiety so I am always scared of something haha!
I am continuing with the Paxil for now, and am going to try in the AM to see if that help the insomnia.
panic_down_under
03-06-17, 05:39
Panic, I didn't know you could take Mirtazapine and Paxil together, isn't there a risk of serotonin syndrome?
No, because while mirtazapine is classified as an antidepressant, it is mostly just a potent antihistamine with only a very weak affect on serotonin. To quote arguably the world's leading serotonin syndrome/toxicity (SS/ST) expert, Dr Ken Gillman (http://scholar.google.com.au/citations?user=ea6KeD0AAAAJ&hl=en):
As I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C. This scenario has already been enacted, over a decade, with the antidepressant mirtazapine, which was claimed, erroneously, to have serotonergic activity. Many poor quality case reports of ST with mirtazapine were published. This probably led to misdirected treatment of overdoses, some of which may have caused morbidity. It took several reviews to correct this error and establish that mirtazapine cannot cause ST.
PK Gillman, 2010 PDF (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550296/pdf/13181_2010_Article_84.pdf)
Moreover, mirtazapine is a moderate serotonin 5-HT2a (https://www.ncbi.nlm.nih.gov/pubmed/17067560) receptor antagonist (blocker). The recommended treatments (http://www.psychotropical.com/treatment-of-serotonin-toxicity) for severe serotonin syndrome are the more potent 5-HT2a receptor antagonists cyproheptadine and chlorpromazine. 5-HT2a antagonists prevent the body temperature spike which does the damage in SS.
I have never taken a "cocktail" of meds, only psych med I have ever taken before 4 months ago was the Zoloft I took for years, so being already on 600MGs of Lyrica, and now 10mgs of Paxil...I guess I am scared to add yet ANOTHER drug to the mix.
I'm not a fan of poly pharmacy either. I'm only suggesting mirtazapine as a temporary sleep aid, not as a therapeutic agent, and now that it has registered you're in America, not Britain, I'm recommending immediate-release trazodone (Desyrel) instead. At low doses, 25-75mg it acts only as a very sedating antihistamine, just like mirtazapine, but it has a much shorter half-life, 3-4 hours compared to 20-40 h for mirtazapine, so it is less likely to cause daytime sedation.
I assume the intention is to wean off the pregabalin once the paroxetine kicks-in, in which case you'll soon be back to one med anyway if it works.
Panic,
Yes that Is the plan to wean off the pregabalin when I am stable, though at the point that feels an impossibility. In your opinion is the Paxil a good option, even though I failed on the Zoloft and Lexapro? I don't know what is going on as I was completely stable on Zoloft for such a long time, and this time this SSRIs are not kicking in, and I feel they have made me worse. Can the 10mgs of Paxil be an effective dose? Or do you think I will need more? Do you take meds for anxiety? Sorry for all the question, just seem like you know a lot about this stuff and I am relatively naive, as I simply started Zoloft 8 years ago after a rough year of anxiety, and I just started to feel better as I went along. Each week was better than the last, until I eventually felt like my old self again (albeit with some anxiety blips a couple of times a year that would last a week or two). I didn't really have to know about other meds, or combos, as it just simply worked...this time I have certainly not been as fortunate.
---------- Post added at 10:31 ---------- Previous post was at 10:09 ----------
Also, skipped the Paxil (3rd one) dose last night, took it this morning. Did not have early morning awakening, which was good, but woke up with more anxiety...I just can't figure this out...haha.
panic_down_under
03-06-17, 23:22
In your opinion is the Paxil a good option, even though I failed on the Zoloft and Lexapro?
It may not be. Generally if two SSRIs have failed the likelihood of a third working is pretty low. Usually, a dual action SNRI (which rules out venlafaxine (Effexor) and desvenlafaxine (Pristiq), btw, as they are really only SSRIs), or TCA would be the better bet. However, Paxil also a reasonably effective norepinephrine, aka noradrenaline reuptake inhibitor which might just be enough to make a difference.
I don't know what is going on as I was completely stable on Zoloft for such a long time, and this time this SSRIs are not kicking in, and I feel they have made me worse.
How much Zoloft were you on, and if it was less than the recommended maximum 200mg dose did you try increasing it up to that?
Can the 10mgs of Paxil be an effective dose? Or do you think I will need more?
10mg is a sub therapeutic dose for most so should not be taken for long periods as it may increase the risk of the med pooping-out. You should take at least 20mg, and my guess is you'll need more given the other SSRIs failed.
Do you take meds for anxiety?
I've been on antidepressants pretty much continuously since March 1987 and have been on 225mg dosulepin, aka dothiepin, for the last 21 years.
Also, skipped the Paxil (3rd one) dose last night, took it this morning. Did not have early morning awakening, which was good, but woke up with more anxiety...I just can't figure this out...haha.
After about 5 days paroxetine plasma levels will stabilize to a steady-state and then not vary much across 24 hours so it won't matter much when you take it.
There was a time I was on a higher dose, 100-150mgs of Zoloft, but I started fish oil supplements and got healthier and my dose for the last 5 years was 50mgs. I got off it in November as I felt I was great and no longer needed it. Had a little anxiety blip in January, nothing bad that I didn't deal with from time to time on the Zoloft. I thought I would be proactive and just get back on the Zoloft, anxiety went through the roof , and I have felt terrible ever since through a trial of Zoloft and then Lexapro. I never got higher than the 50mgs on the trial as even the lose doses were sending my anxiety through the roof, got up to 10 MGs on Kexapro.
I don't know if it is the start on Paxil, or increasing pregabalin to 600mgs, but my anxiety is so bad right now, I honestly can't take it anymore! After 5 months of anxiety hell, I am just done. I feel I will never get back to myself, my kids will never get their Dad back and my Wife will probably leave me. This has just been too much, and it is simply not getting better!
panic_down_under
04-06-17, 01:58
I never got higher than the 50mgs on the trial as even the lose doses were sending my anxiety through the roof, got up to 10 MGs on Kexapro.
How long were you on the 50mg Zoloft, and 10mg Lexapro?
I did 6 weeks on Zoloft, but maybe didn't give it a great chance. I went 3 weeks at 50mgs, then I went down to 25mgs for a week cause I was struggling with increased anxiety. After the week at 25 went back to 50 for a week then back to 25 after that week, probably not the best way to give it a try. With Lexapro I was at 5MGs for a week, the 10mgs for 6 weeks.
panic_down_under
04-06-17, 05:16
I did 6 weeks on Zoloft, but maybe didn't give it a great chance. I went 3 weeks at 50mgs, then I went down to 25mgs for a week cause I was struggling with increased anxiety. After the week at 25 went back to 50 for a week then back to 25 after that week, probably not the best way to give it a try. With Lexapro I was at 5MGs for a week, the 10mgs for 6 weeks.
The Zoloft never really had a chance. Did you switch straight from Zoloft to Lexapro, or was there a med free gap between them?
Straight from 25mgs of Zoloft to 5mgs of Lexapro. Stopped Lexapro on May 3rd or 4th, didn't start Paxil until June 1st.
panic_down_under
04-06-17, 07:23
Straight from 25mgs of Zoloft to 5mgs of Lexapro.
Switching in those circumstances often has the new med kicking-in earlier, but the multiple Zoloft dose changes might have negated any carry over effect.
Stopped Lexapro on May 3rd or 4th, didn't start Paxil until June 1st.
Then you're effectively starting Paxil from a clean slate with kick-in likely to be in the normal 3-12 week window.
Ok, when I up my dose, does that timeframe essentially start over? Or is it just time on the med? Given my previous trials, do you think Paxil is a poor choice?
panic_down_under
04-06-17, 22:46
Ok, when I up my dose, does that timeframe essentially start over? Or is it just time on the med?
The clock starts running from when you begin taking a therapeutic dose which for paroxetine is usually 20mg.
Given my previous trials, do you think Paxil is a poor choice?
It is the best SSRI choice. Whether it is the right one is another matter. When there is no response to two SSRIs usually the best option is to try either a SNRI, or TCA. However, given the circumstances, I don't think we can really say whether Zoloft, or Lexapro failed. It may have been mostly 'operator' error.
I like that, "operator error." I would for sure agree that was the case on Zoloft, but isn't 7 week trial (6 on 10mgs) of Lexapro a pretty good go? Would you have increased the dose instead of discontinuing? If I don't even start counting until 20mgs of Paxil, should I suggest to the doc just going up to get on with it?
---------- Post added at 17:55 ---------- Previous post was at 17:05 ----------
One more question haha. I take a pretty high dose fish oil supplement (I have for years) it was a big reason why I was able to decrease my Zoloft dose from the 100-150 range to 50mgs for the last 4-5 years. Not only did it "help" me lower it, it almost made me as my anxiety would be greater on the higher doses, then would decrease and level out to normal when I would drop the dose. Is it possible this supplement is making it harder for me to get on an SSRI? Or to be honest, the fish oil could have just been placebo the whole time, but it seemed like it made a big difference.
Also, I want to thank both "Panic Down Under" and "Handshan" for your advice and support. There is no reason for two people from Australia to care whether a formally care-free, happy 34YO Father of 3 (10-boy,7-boy,3-girl), and husband of one amazing wife, from the States gets his life back after 4 months of anxiety hell that happened simply because he quit taking a little tablet. You guys have been awesome and I want you to know I am grateful!
panic_down_under
05-06-17, 01:35
but isn't 7 week trial (6 on 10mgs) of Lexapro a pretty good go?
As with all antidepressants it can take 12 weeks for Lexapro to kick-in.
Would you have increased the dose instead of discontinuing?
Yes. You can't say a med isn't effective unless you've maxed out the dose. Some need even a little more.
Is it possible this supplement is making it harder for me to get on an SSRI?
I don't think so. Omega-3 fatty acids, especially eicosapentaenoic acid (EPA), stimulate hippocampal neurogenesis just as antidepressants do, but it isn't as potent. A couple of studies have shown taking fish oil capsules can speed up antidepressant kick-in a little, but others found no such benefit.
Imho, fish oil is worth taking, however, be careful while on SSRIs as both are anticoagulants and there is an increased bleeding risk at high fish oil doses. I wouldn't take more than 4,000mg day while on any SSRI (or some SNRIs and TCAs), and dial even that back if you begin bruising more easily, or have nose, or gum bleeding, etc. Also, avoid aspirin and other NSAID painkillers (http://www.medicinenet.com/nonsteroidal_antiinflammatory_drugs/article.htm), such as ibuprofen and naproxen, etc, while taking both (taking NSAIDs for more than a few days while on an SSRI is probably not a good idea anyway). There are no bleeding issues with acetaminophen, aka paracetamol.
As with all antidepressants it can take 12 weeks for Lexapro to kick-in. Yes. You can't say a med isn't effective unless you've maxed out the dose. Some need even a little more.
If that is true, I wish my psych doc would have recommended it. Good chance I would be nearly recovered right now instead of literally back to square one. Thanks for helping ease my mind about the fish oil, I take about 2Gs of it (approx 1500EPA and 500DHA). Well I guess nothing left to do now but get on with life the best I can during yet ANOTHER excruciating SSRI startup. 4 months has been a long time and has taken its toll on me, my wife and family, and my work (I own 3 car dealerships). I can recover from this right? I mean I haven't been somehow permanently damaged by all the medication during the last 4 months, and even over the last 8 years? I just know it is a long road ahead, and I wish I could see a light at the end of the tunnel, 4 dark months wanderng in the tunnel, really suck. Maybe I am starting to see a light, just hope it isn't a train coming at me!
panic_down_under
05-06-17, 07:43
I own 3 car dealerships
OMG, you're an evil used car salesman <backs away while frantically searching for a crucifix and garland of garlic> :winks:
I can recover from this right?
If you did it once there is no reason why you can't again.
I mean I haven't been somehow permanently damaged by all the medication during the last 4 months, and even over the last 8 years?
In the last 30 years I've taking far more antidepressants than you probably ever will and my brain hasn't dissolved yet. In addition to reversing the effects of cortisol, there is some evidence SSRIs could protect against Alzheimer's disease (http://www.biosciencetechnology.com/article/2014/05/anti-depressant-reduces-alzheimers-plaque-growth-78-percent) and maybe reverse plaque buildup (see also: Nelson RL (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/17368447/), 2007).
OMG, you're an evil used car salesman <backs away while frantically searching for a crucifix and garland of garlic> :winks:
Haha, exactly!
If you did it once there is no reason why you can't again.
I know, it was just so easy last time. Started Zoloft, started to feel better. This time I have gotten much worse startup anxiety, and it feels worse, but you are right, we all eventually pull through!
In the last 30 years I've taking far more antidepressants than you probably ever will and my brain hasn't dissolved yet. In addition to reversing the effects of cortisol, there is some evidence SSRIs could protect against Alzheimer's disease (http://www.biosciencetechnology.com/article/2014/05/anti-depressant-reduces-alzheimers-plaque-growth-78-percent) and maybe reverse plaque buildup (see also: Nelson RL (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/17368447/), 2007).
Interesting article, good to know. I know I haven't actually damaged my brain, but when the SSRIs feel like they aren't working this time, when they did so well for 8 years, I can't help but wonder WTF! I took a little 50mg tablet of Zoloft for 8 years, and my life was great...deciding to stop in October was the worst mistake of my life!
Hi and sorry for jumping in on your thread but I'm in a similar position to you Utah and just wanted to let you know you have my sympathies. I was on venlafaxine for 2 years and came off last July only to have GAD return with a vengeance in October and I've been battling ever since. Went back on the ven without success, was then put in mirtazapine (early promise but ultimately didn't deliver) and currently on 450mg per day Pregabalin (was fine in this at 300mg for nearly 2 weeks before it all started going downhill again) but I've had a horrendous few days so not sure that the max dose of 600mg will do any good either.
So what next? 8 months of living in this state, never being able to relax is the worst and with Pregabalin not doing much I really don't know what to do. My next psych appointment is 14 July and I honestly don't know how I'm going to survive that long.
However I will survive and so will you Utah because as you say, you've recovered before and you will again although finding the right medication may take time. I had pneumonia about 10 years ago which whilst horrible was treated successfully with 4 weeks of antibiotics. How I wish anxiety was as easy to treat!
Still, we are lucky to have people like Panic Down Under and Hanshan to keep us going in the meantime.
I hope you find the right balance of meds soon.
panic_down_under
05-06-17, 22:14
I took a little 50mg tablet of Zoloft for 8 years, and my life was great...deciding to stop in October was the worst mistake of my life!
Been there, done that, got the tee shirt! :weep: The first time I hit the wall again after about 9 months, the second I had nearly 18 med free months and the third time it took about 6 for the panic disorder to reassert itself. I've rarely missed a med dose since.
Hi Utah49er - Psychoactive medications from your doctor have been getting safer and safer. Starting up and discontinuing an SSRI or SNRI can be less than pleasant, but I don't think taking them does any permanent damage, and may do some long-lasting good (but yes, if you search around on the internet, you'll find people saying these meds are useless/little short of poison, etc).
Three car dealerships! - I'd be stressed out of my mind handling just one! I've just come back to Australia after six years working in Japan and bought a new car for the first time in my life - a General Motors (Holden in Australia) Astra, based on the German Opel brand, but I've just found out that GM has sold Opel to (I think) Citroen. But these days, I don't worry - I'm happy with the car.
Been there, done that, got the tee shirt! :weep: The first time I hit the wall again after about 9 months, the second I had nearly 18 med free months and the third time it took about 6 for the panic disorder to reassert itself. I've rarely missed a med dose since.
When you would restart did your meds work quickly, or did it ever take a while to find the right one?
---------- Post added at 10:16 ---------- Previous post was at 10:08 ----------
Hi Utah49er - Psychoactive medications from your doctor have been getting safer and safer. Starting up and discontinuing an SSRI or SNRI can be less than pleasant, but I don't think taking them does any permanent damage, and may do some long-lasting good (but yes, if you search around on the internet, you'll find people saying these meds are useless/little short of poison, etc).
Three car dealerships! - I'd be stressed out of my mind handling just one! I've just come back to Australia after six years working in Japan and bought a new car for the first time in my life - a General Motors (Holden in Australia) Astra, based on the German Opel brand, but I've just found out that GM has sold Opel to (I think) Citroen. But these days, I don't worry - I'm happy with the car.
Yes, the car dealerships are stressful, but ironically when my anxiety is this high that kind of stuff doesn't bug me, and is often a nice distraction. I am weird in that when my anxiety is high the only thing I am worried about is...well my anxiety. I think about it all the time, and am always checking on myself to see how I feel. I know it only fuels it, but it is the way it is. I am working on both accepting the fact my mind wants to check on anxiety, but also trying to gently place my attention elsewhere when it does...but it is hard. Hopefully the Paxil will start to kick in (though I think Panic may be right in that I have been trying these meds at too low of a dose, but they have seemed to increase my anxiety so I have been scared of higher doses) and help me with these ruminations. So yes, the business is stressful, so is raising kids ect, however those are the stresses I like and wish I could focus on instead of always focusing on anxiety. Is that weird? Does that even make sense to anyone?
---------- Post added at 10:21 ---------- Previous post was at 10:16 ----------
Hi and sorry for jumping in on your thread but I'm in a similar position to you Utah and just wanted to let you know you have my sympathies. I was on venlafaxine for 2 years and came off last July only to have GAD return with a vengeance in October and I've been battling ever since. Went back on the ven without success, was then put in mirtazapine (early promise but ultimately didn't deliver) and currently on 450mg per day Pregabalin (was fine in this at 300mg for nearly 2 weeks before it all started going downhill again) but I've had a horrendous few days so not sure that the max dose of 600mg will do any good either.
So what next? 8 months of living in this state, never being able to relax is the worst and with Pregabalin not doing much I really don't know what to do. My next psych appointment is 14 July and I honestly don't know how I'm going to survive that long.
However I will survive and so will you Utah because as you say, you've recovered before and you will again although finding the right medication may take time. I had pneumonia about 10 years ago which whilst horrible was treated successfully with 4 weeks of antibiotics. How I wish anxiety was as easy to treat!
Still, we are lucky to have people like Panic Down Under and Hanshan to keep us going in the meantime.
I hope you find the right balance of meds soon.
I am sorry you are going through this as well, it is terrible and I wouldn't wish it upon anyone, but it is sometimes good to know you are not alone. I get your comparison with pneumonia, I had testicular cancer when I was 20 (before I ever experienced anxiety, and this event did nothing to trigger anything) and I would take that battle any day over this one. Too bad to hear the pregabalin/mirtazapine combo hasn't worked for you, it was what I was wanting to try to be honest simply because I am sick of the SSRIs increasing anxiety and mirt doesn't seem to have that reputation.
panic_down_under
06-06-17, 23:33
When you would restart did your meds work quickly, or did it ever take a while to find the right one?
The meds usually take as long the second time as the first. No antidepressant is *intrinsically any better than the others, however, one or two may be more effective for an individual and it can take a few med switches to pin them down.
* but generally, MAOIs > TCAs > SNRIs > SSRIs and clomipramine and fluvoxamine may be for OCD
Back in 1987 when my life first spirally out of control there were fewer med choices. I was lucky that the first one tried, imipramine (Tofranil) worked well, albeit only at very high doses. The MAOI class med phenelzine (Nardil) prescribed after the first relapse was even better, but the dietary restrictions were a pain in the butt (modern food processing techniques make this much less of a problem now). I then tried a couple of SSRIs when they become available, but they all make me manic, as did the SNRI (but really only a SSRI) venlafaxine (Effexor), so it was back onto a TCA. My current one has been working extremely well for over 20 years.
10mg is a sub therapeutic dose for most so should not be taken for long periods as it may increase the risk of the med pooping-out. You should take at least 20mg, and my guess is you'll need more given the other SSRIs failed.
Would you recommend increasing to high doses even though my experience so far this go around has been that the SSRIs have increased my anxiety? Because of this I have certainly been scared of higher doses. At what point and how often would you increase the dose?
---------- Post added at 19:39 ---------- Previous post was at 19:35 ----------
My current one has been working extremely well for over 20 years.
Is that all you take to keep your anxiety and panic away? Would you say you have been back to your normal self for 20 years?
panic_down_under
07-06-17, 06:30
Would you recommend increasing to high doses even though my experience so far this go around has been that the SSRIs have increased my anxiety? Because of this I have certainly been scared of higher doses.
SSRIs will often heighten anxiety at the beginning and also maybe for a while after dose increases because of an initial surge in serotonin activity. However, within a few weeks the brain should respond by decreasing serotonin synthesis and expression causing anxiety levels to drop back to around baseline until the med kicks-in.
The anxiety spike is unavoidable, but small doses of a benzodiazepine (BZD) will usually contain it, as often will low doses of hydroxyzine (Vistaril) if your doctor doesn't prescribe BZDs. Hydroxyzine is a prescription antihistamine with pretty good anti anxiety properties. It isn't as potent as the BZDs, but often potent enough. Another alternative is small doses of the antidepressant mirtazapine (Remeron) which is also a powerful antihistamine.
At what point and how often would you increase the dose?
If there is no significant improvement after 8-10 weeks at a particular dose. And don't be worried about going to the recommended maximum if you need to. Your brain won't melt. One of the curious things about antidepressants is that while they force significant changes to the brains of those with a disorder, not much happens within the brains of controls. At least this is true of mice.
Is that all you take to keep your anxiety and panic away?
I also take 4,000mg of fish oil, 1,800mg of N-acetyl-cysteine and 600mg magnesium, all of which may have a small affect on anxiety and depression, but I take them for my heart, lung and leg cramps respectively, not for their reputed anti anxiety properties. I was doing just as well before taken the supplements. I'm also on a BP med.
Would you say you have been back to your normal self for 20 years?
I haven't had a panic attack for 20 years. However, anxiety does start to creep back in if I drop the antidepressant dose from 225mg to 200mg, so the extra 25mg must put me into my personal dose sweet spot.
Hi Utah49er - I can understand what you say about work being stressful but a distraction at the same time. I was in teaching, and I'd get very stressed in anticipation of a class, but then mostly once I got in the classroom I was fine. (Unfortunately, I started getting panic surges while teaching, but with the meds that stopped and the pre-class stress came down to a bearable level).
I hope you're travelling okay this week.
However, within a few weeks the brain should respond by decreasing serotonin synthesis and expression causing anxiety levels to drop back to around baseline until the med kicks-in.
Ok, although it felt like on my six weeks of Lexapro it never went down to baseline...maybe it did but my baseline was really high. I never stopped waking early in a panic during the six weeks on Lexapro...and that sucked!
If there is no significant improvement after 8-10 weeks at a particular dose.
So would you stay at 10mgs for 8-10 weeks, then 20 for 8-10 weeks, then 30..etc? That seems like a long trial if it isn't working. Since you think (and I tend to agree as playing with lower doses have done little for me this time) I will need a higher dose, should I move through the doses a little quicker? I am currently on day 7 at 10mgs and still on the 300mgs x2 of Pregabalin. I Take them at about 11 and 11. I do think the Pregablin helps me to sleep better during the Paxil startup, and I am mentally handling the anxiety increase this time, but it is still strong (even on the Pregabalin).
---------- Post added at 09:55 ---------- Previous post was at 09:53 ----------
Hi Utah49er - I can understand what you say about work being stressful but a distraction at the same time. I was in teaching, and I'd get very stressed in anticipation of a class, but then mostly once I got in the classroom I was fine. (Unfortunately, I started getting panic surges while teaching, but with the meds that stopped and the pre-class stress came down to a bearable level).
I hope you're travelling okay this week.
Thanks Hanshan! Another week, another really tough grind through anxiety. Man I hope I start coming out the other side of this soon.
panic_down_under
07-06-17, 23:09
So would you stay at 10mgs for 8-10 weeks, then 20 for 8-10 weeks, then 30..etc?
Not at 10mg because that is a sub therapeutic starter dose. It should been increased to 20mg after 7 days. But I would give 20mg more time.
Since you think (and I tend to agree as playing with lower doses have done little for me this time) I will need a higher dose, should I move through the doses a little quicker?
I suspect you will need more than 20mg, but there is no way of really knowing. You could go up to 30mg and then 40mg after a few weeks if you wish.
Not at 10mg because that is a sub therapeutic starter dose. It should been increased to 20mg after 7 days. But I would give 20mg more time.
Sounds good, thanks for your advice! I will be starting 20mgs tomorrow...and then my clock starts counting towards recovery...correct? Does the clock reset if I up the dose?
Also, I was just wondering, from your posts to me, you seem to view Mirtazapine as little more than a sleep aid or anti-histamine. From the clinical trials I have read, it was found to be at least as effective as many older anti-depressants (especially for agitated depression with insomnia). You are obviously more knowledgeable than me at these things, and was wondering your opinion on Mirtazapine.
panic_down_under
09-06-17, 02:19
I will be starting 20mgs tomorrow...and then my clock starts counting towards recovery...correct? Does the clock reset if I up the dose?
Yes, and no. However, there may be a temporary increase in side-effects after dose increases, although they are usually not as severe as at the beginning.
from your posts to me, you seem to view Mirtazapine as little more than a sleep aid or anti-histamine.
Yes, because this is all it is. It is about 1,000 times more effective at blocking the histamine HI receptor than any other. It is not a classic antidepressant, neither significantly inhibiting neurotransmitter reuptake, or promoting neurogenesis.
I have read, it was found to be at least as effective as many older anti-depressants (especially for agitated depression with insomnia).
Yes, it can be effective for both because of its sedative effects, particularly at lower doses. It can, however, become agitating at the upper end of the dose range.
was wondering your opinion on Mirtazapine.
I think it can be a better longer term option than benzodiazepines as a sedative for anxiety, as a sleep aid (but when available trazodone is better, imho) and it may speed up SSRI kick-in a little.
But I'm not a fan because it also has some potential serious long-term side-effects such as diabetes due to the large weight-gains it often causes by stimulating carbohydrate cravings, and there is also a risk of liver injury with about 10% (https://livertox.nih.gov/Mirtazapine.htm) of those taking the drug showing liver abnormalities, although usually these are not significant. However, a small number may develop blood dyscrasias (PDF (http://161.146.224.20/pdf/aadrb-0706.pdf)) which is the medical term for a wide range of blood abnormalities (http://www.instah.com/miscellaneous-problems/blood-dyscrasias-types-causes-symptoms-treatment/) such as the white blood cell disorders neutropenia (https://en.wikipedia.org/wiki/Neutropenia) and agranulocytosis (https://medlineplus.gov/ency/article/001295.htm). While rare, these should be watched for. Typical symptoms are fever, sore throats and other signs of infection.
Mirtazapine is derived from the older antidepressant mianserin which was initially popular, particularly in Europe until doctors realised it was slightly less effective than an equivalent dose of M&Ms. So the makers rejigged the chemistry a little to create mirtazapine which they claimed was a much more potent alpha 2-adrenoceptor (a2) and serotonin 5-HT2a receptor antagonist. Both claims are untrue. The mianserin a2 binding potential is between 23-73 *Ki, that of mirtazapine 58-141 Ki. For 5-HT2a the binding potentials are mianserin: 0.36-7.0 Ki, mirtazapine 2.0-17 Ki. Mirtazapine remains popular while mianserin is rarely prescribed these days because the makers spend a lot of money marketing the drug to doctors.
* The Ki value is based on the amount of the drug needed to occupy 50% of the target receptors, so the lower the Ki the more potent the med.
Hi Utah49er - Take care with my compatriot, Panic_Down_Under, as he quotes a lot of science, but does so selectively.
For example, he says: "there is also a risk of liver injury with about 10% of those taking the drug showing liver abnormalities, although usually these are not significant".
The actual quote reads: "Liver test abnormalities have been reported to occur in up to 10% of patients on mirtazapine, but elevations are usually modest and rarely require dose modification or discontinuation".
There is a big difference between a liver abnormality and a liver test abnormality, particularly when "elevations are usually modest and rarely require dose modification or discontinuation". Most blood tests show transient small elevations or decreases in one or two measurements that aren't of major significance.
While researching information online is admirable, with the greatest respect I feel that Panic_Down_Under favours the drugs of thirty or forty years ago (MAOIs and TCAs, followed by SSRIs), and uses his quotes to support his pre-existing beliefs. However, for example, the toxicity and side-effect profile of mirtazapine is nothing compared to MAOIs and TCAs, which can be downright dangerous to deadly in overdose, one reason that they are sparingly prescribed today.
As for the neurotransmitter action of mirtazapine, it boosts serotonin and noradrenaline activity through non-classic, novel means. Neurotransmitter re-uptake inhibition is only one mechanism for increasing neurotransmitter activity - that's what makes mirtazapine's novel activity a good alternative to classic SSRIs (selective serotonin re-uptake inhibitors).
Utah49er, do ask for advice and support, but we are not doctors or qualified medical staff on this website, and shouldn't try to fill that role. Certainly there is a little bit of knowledge, but mostly the support comes from people who have taken these meds and faced similar problems.
Utah49er, do ask for advice and support, but we are not doctors or qualified medical staff on this website, and shouldn't try to fill that role. Certainly there is a little bit of knowledge, but mostly the support comes from people who have taken these meds and faced similar problems.
Yes I understand, and have been very grateful for the support and advice. As I said, I was scared of another SSRI trial and was hoping to try Mirtazapine as it seemed much less painful to start-up. Alas, that didn't happen and I am doing my Paxil startup now. It has gone ok, I have felt some increase in anxiety, but I have been managing. Just started on 20mgs today after 8 days on 10mgs. I was just asking Panic's opinion on Mirt, as he has insinuated he didn't think much of it as a primary AD for anxiety, but you and others have had great success. I have to think at some point and SSRI will kick in and work as Zoloft was effective, even at its lowest dose for 8 years, and it would make no sense I couldn't get back to that with an SSRI again after just a 4 month break from them.
I am now one week on a full 20MG dose of Paxil to go with my 600mgs of pregabalin...I feel awful! I woke up in a panic at 5:30AM (something I did a lot during my trial of Lexapro). I know I need to be patient, but it is hard to have faith as Lexapro never kicked in after 6 weeks on therapeutic dose. I need something to work, I just want to get back to my life! The pregabalin helped, but it seems like it is now just being overpowered by the startup effects of Paxil. I just don't get why after a short 4 month break from Zoloft, SSRIs now increase my anxiety so much. I am sure I need to just be patient, but this is REALLY hard. Any advice?
Hi Utah49er - It is horrible when you are hoping so much for something to work. Hopefully it is just a blip. Many will attest that starting up can actually increase anxiety, but then have a beneficial effect.
Maybe you went up to 20 mg too quickly? The usual approach for anxiety is "start low, go slow".
Good luck, and I hope you are feeling better.
I wish I could offer advice but right now I'm not best qualified to do that! What I can offer is a listening ear if you want to vent. The best people to vent to are those who truly understand what you're going through and how all consuming anxiety can feel.
If it makes you feel any better (and not so alone), I had a horrific day on Monday, drove the 30 miles back from work literally sobbing the whole way (feeling like I would never get better) and ended up at the GP surgery crying on a lovely receptionist who arranged for me to speak to the emergency doctor. I now have a small supply of lorazepam to take the edge off things when I really can't cope.
I've since spoken to my own doctor and am now weaning off mirtazapine and will be switching back to venlafaxine (on the advice of the psych) to augment the pregabalin. I'm not holding out much hope though as ven did nothing for me when I went back on it before. Still, at least with the aid of lorazepam I've had a few slightly calmer days.
So the upshot is it looks like there's not gonna be a quick fix for either of us but at least there's always plenty of support on here.Has your doc ever given you any benzos for short term relief? GPs in the UK normally prescribe diazepam (valium) but even 10mg doesn't touch my anxiety hence the lorazepam (same effect, slightly different action and duration of effect).
I truly hope the meds kick in soon for you. Hopefully soon you will be able to look back and this will all seem like a bad dream,
Hi Utah
How are you getting on now? Hope the meds have started to kick in now?
Hi Utah
How are you getting on now? Hope the meds have started to kick in now?
Pixie, you are so sweet to think of me and I am desperately hoping and praying (hope this is ok, but I am a religious man and that is how I do things) for you and your recovery! How are you, have you started the Effexor again?
I am doing ok, not sure if any better or worse, but holding steady. I have windows of time where I can almost feel my true self coming back, then a wave of anxiety closes the window haha. I do think eventually I will get there on the Paxil, but I think maybe the fact I quit cold turkey (was on the "lowest dose" of Zoloft at 50mgs, I figured I could just stop taking them) my nervous system may just be highly sensitive to SSRIs and they greatly increase my anxiety for a while. It may take longer than usual for me to get there due to this, but I am confident, given time, I will get there (if i can be patient...good luck right?) I have seen this theory of being sensitized to meds due to quitting cold-turkey, or quitting in general, being floated around the internet. Maybe Panic Down Under or Hanshan could weigh in on this as they seem to understand this stuff more than others. Anyway, it is still early (11 days at 20mgs) and I certainly have had some wins (felt almost normal at Father's Day BBQ at my Dad's) but my general anxiety has been VERY high the last 3-4 days. At times almost unbearable, but at times very manageable and I can feel myself coming back. Hopefully the good 'windows" continue to get more frequent and the "waves" get weaker and less frequent. I think the Pregabalin is helping me sleep and with the start-up anxiety, but I am waking early like I did on the other SSRIs (6AM though this time not the 4:30 or 5 on the Zoloft and Lexapro).
---------- Post added at 17:32 ---------- Previous post was at 17:16 ----------
I don't agree with a lot this site says, but this kinda sounds like us Pixie:
http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/
Again I would be interested in thoughts about this from people who know much more than I about these drugs. I am just an average guy trying to figure out what the hell happened to him.
Hi Utah
I'm glad that you feel things may be starting to improve. I hope that the good feelings continue and soon anxiety is a thing of the past. Thank you for your prayers. I dropped the mirtazapine dose on the advice of my doctor and took my first Effexor on Sunday but I felt so truly awful that I took the mirtazapine again and I'm now so scared of feeling even worse I don't know what to do for the best! I've been taking mirtazapine for 6 months so I felt that stopping it over 3 days was quite quick. Maybe I need more time to get off it before starting Effexor? I just don't know any more.
I'm really wish I could just do what all of the self help books say and just accept the anxiety for what it is. I've been fighting this for 9 months now and whilst some days are better than others, for the most part I'd describe it as a living hell. It's there as soon as I open my eyes in the morning and the worst part is, I'm not actually anxious about anything reallly. I just dread everything as I know I'm going to feel awful all day. Is that how yours is?
Sorry - don't mean to sound so self pitying but I just don't see an end to this!
Sending prayers for you that you start to feel more like yourself again soon.
Quick update: just managed to speak to my psychiatrist re the meds and she said it's safe to start taking the Effexor before tapering off mirtazapine. She's also brought my next appointment forward so seeing her 4 July. So I will try again with the Effexor tomorrow and see how I go on that before removing mirt and/or Pregabalin. Anything is worth a try!
Yes, I was going to tell you I have known many people who find the Mirtazapine/Effexor combo a good one. So while it may not be for you, there is certainly no hurry to get off the Mirtazapine.
Sorry you are struggling, I actually had a fairly good day yesterday, but then was up at 5AM today and not able to go back to sleep. That combined with the stress of watching my son's tennis matches today, I am having a pretty bad anxiety day. Sucks cause yesterday was, as I said, actually pretty good. So disappointing to feel like you are finally seeing some light, only to come crashing back down.
Just know you will get there, I actually think going back on Effexor is going to be just the thing you need. If it was me I would continue to take the Mirtazapine for sleep and the Pregabalin to take and edge off any Effexor start-up symptoms. I know it seems like a lot of meds, but we need to get ourselves functional and stable, then figure out what we can start weaning ourselves off of.
Mirtazapine plus venlafaxine have been found to be a good combination for treating depression, as they work in different ways (NaSSA + SNRI). The combination may also be helpful for anxiety, so worth a try. It's really a case of trial and error to see what works, but have courage - something will eventually.
Hanshan, I was hoping you and Panic would weigh in on the idea that for me and Pixie quitting our AD shocked our central nervous system and the best thing we could do is to get on either our original AD or a similar one and stay on it for 2+ months to give our systems time to adjust and desensitize.
Pixie, just wondering what your symptoms are? Do you have problems sleeping? Early wakings (like at 3-6AM with cortisol/adrenaline spikes). When is your anxiety worse in your day? When is it best? I know everyone is different and responds differently to meds and such, but we are so similar in our experience, I am just wondering if our symptoms are also similar.
Hi Utah
I'm glad that you feel things may be starting to improve. I hope that the good feelings continue and soon anxiety is a thing of the past. Thank you for your prayers. I dropped the mirtazapine dose on the advice of my doctor and took my first Effexor on Sunday but I felt so truly awful that I took the mirtazapine again and I'm now so scared of feeling even worse I don't know what to do for the best! I've been taking mirtazapine for 6 months so I felt that stopping it over 3 days was quite quick. Maybe I need more time to get off it before starting Effexor? I just don't know any more.
I'm really wish I could just do what all of the self help books say and just accept the anxiety for what it is. I've been fighting this for 9 months now and whilst some days are better than others, for the most part I'd describe it as a living hell. It's there as soon as I open my eyes in the morning and the worst part is, I'm not actually anxious about anything reallly. I just dread everything as I know I'm going to feel awful all day. Is that how yours is?
Sorry - don't mean to sound so self pitying but I just don't see an end to this!
Sending prayers for you that you start to feel more like yourself again soon.
Quick update: just managed to speak to my psychiatrist re the meds and she said it's safe to start taking the Effexor before tapering off mirtazapine. She's also brought my next appointment forward so seeing her 4 July. So I will try again with the Effexor tomorrow and see how I go on that before removing mirt and/or Pregabalin. Anything is worth a try!
Pixie, I haven't heard from you and wondering how you are getting on with your start-up of effexor? Hopefully not too many adverse effects and you will start seeing benefits soon!
Hi Utah
Well it's been almost a week on Effexor but at the moment I don't feel any different. Anxiety has been high and I've had a few "meltdowns" where I've just sat and cried as I feel as though I'll never get better. I haven't posted on here as I just feel as though I come across as "poor me" all the time!
You asked what my symptoms are; well the list is long and they are constant as in there all day every day:
My chest feels like there's a tight band round it, my arms constantly feel like I have something crawling in them, I have an upset stomach, feel sick most of the time and just generally feel like I'm on the edge of full blown panic and may burst into tears at any time. Just the thought of getting through the day is awful.
However, I have been like this for the best part of 9 months now so I am surviving.
It's early days on Effexor yet though and I'm only on a low dose until Thursday when I have to increase so time will tell.......
So how about you? What symptoms do you have? Hopefully you are starting to feel better now and the meds are kicking in for you? One of these days one of us has to have a breakthrough!
Take care of yourself and sending positive vibes your way.
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