View Full Version : Worse before better on paroxetine?
Hi I’ve suffered from anxiety with panic attacks and depression for a few years now and have tried many many different medications.
The first one I tried was pristiq because it had worked for me about 10 years ago during a previous depressive/insomnia episode. I was on it for three years and came off it without any problems. This time around it just made me more anxious. ☹️
After this I tried lexapro, atypicals, anti psychotics, tricyclics, and even an MAOI which felt like I was on speed. 😬
Amitriptyline and lexapro were probably the best of a bad bunch.
Now Dr has started me on paroxetine 10mg daily. She thinks it’s the best fitting SSRI for my condition .
I started this dose 2 weeks ago and she wants me to go up to 20mg. Since starting paroxetine I found myself taking 2mg Valium daily! Not a lot but I don’t want to go down the benzo path.
The thing is I actually feel more anxious and depressed. I’ve only had one brief happy period since being on it. So I’m naturally fearful of increasing my dose.
I can’t see my psych as she is on holidays but have booked in to see my GP for advice.
Has anyone had luck on 10mg paroxetine? And did you feel worse before getting better?
I mean how long am I supposed wait? I know literature says 4-6 weeks but that seems like a really long time right now…
Thank you in advance people.
John.
panic_down_under
23-06-21, 13:35
Hi I’ve suffered from anxiety with panic attacks and depression for a few years now and have tried many many different medications.
:welcome: to NMP, John,
The first one I tried was pristiq because it had worked for me about 10 years ago during a previous depressive/insomnia episode. I was on it for three years and came off it without any problems. This time around it just made me more anxious.
Antidepressants (ADs) can be less effective the second time requiring a higher dose to achieve the same level of control and the initial side-effects may be more severe and/or different too. How long did you take desvenlafaxine (Pristiq) this time and what was the highest dose?
After this I tried lexapro, atypicals, anti psychotics, tricyclics, and even an MAOI which felt like I was on speed. 😬
Amitriptyline and lexapro were probably the best of a bad bunch.
Which of the tricyclics and MAOIs did you try, what was the maximum dose taken and how long were you on that dose? Did you stop because it wasn't working, or for other reasons?
Now Dr has started me on paroxetine 10mg daily. She thinks it’s the best fitting SSRI for my condition
With the possible exception of clomipramine (Anafranil) and fluvoxamine (Luvox) for OCD, no AD is intrinsically more effective than the others for specific disorders, or generally, but one or two will usually be better than the others for an individual both in effectiveness and tolerability. It all comes down to how they mesh with individual biology. Unfortunately, there is still no reliable way of determining the best med/s except by trial and error.
I started this dose 2 weeks ago and she wants me to go up to 20mg. Since starting paroxetine I found myself taking 2mg Valium daily! Not a lot but I don’t want to go down the benzo path.
Definitely take diazepam if you need to as white-knuckling through anxiety/panic is counterproductive, however, the biggest problem with benzodiazepines (BZDs) isn't the dependency issue as many think, some of the ADs can be harder to quit, but that BZDs inhibit neurogenesis, the mechanism by which ADs (also therapy) work (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Song J (https://www.kurzweilai.net/how-the-brains-stem-cells-find-out-when-to-make-new-neurons/comment-page-1#comment-96481), 2012; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).
The thing is I actually feel more anxious and depressed. I’ve only had one brief happy period since being on it.
No AD will work within 2 weeks, except by a usually short-live placebo response, and they very often make anxiety and/or depression worse at the beginning by increasing serotonin activity before biofeedback kicks-in to reduce serotonin synthesis and release. Both disorders are caused by high brain stress hormone levels *killing brain cells in the two hippocampal regions of the brain and inhibiting the growth of new ones which causes the hippocampi to atrophy. ADs work by stimulating the growth of new hippocampal cells. These cells and the connections they form produce the therapeutic response, not the ADs directly. It takes about 7 weeks (http://cshperspectives.cshlp.org/content/7/9/a018812.full) for neurons to grow and mature, however, improvements in mood may begin a few weeks earlier with kick-in usually occurring in the 4-12 week range.
*See: Depression, antidepressants, and the shrinking hippocampus (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/); Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act: A primer... (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/). As per above, therapy works (https://doi.org/10.1016/j.biopsych.2013.05.017) through hippocampal neurogenesis too, as do Omega-3 fatty acids/fish oil (http://www.ncbi.nlm.nih.gov/pubmed/23746276) and exercise (https://doi.org/10.3727%2F096368910X532846) to lesser degrees though they can make a significant difference in mild cases.
So I’m naturally fearful of increasing my dose.
Most serotonergic ADs, including paroxetine, need to be taken at doses high enough to saturate about 80% (https://pubmed.ncbi.nlm.nih.gov/15121647/) of the serotonin transporters (5-HTT) to initiate and sustain neurogenesis. Unfortunately, there is no readily available test to determine the dose needed to achieve this for individuals. The minimum recommended dose has been shown to achieve this. Taking less may not be enough, and even worse, may increase the odds of the med pooping-out by inhibiting neurogenesis every time plasma levels drop below that required to sustain it.
The rule of thumb on this is the increase the dose no earlier than 5 times the half-life of the med, which for paroxetine is 21 hours x 5, so 5 days. Upping it earlier may increase the severity of any initial side-effects, but delaying and increase won't significantly reduce their severity no matter how long the delay.
I mean how long am I supposed wait? I know literature says 4-6 weeks but that seems like a really long time right now…
Unfortunately, there is no way of speeding up the process. It is what it is. :sad:
Ian
Hi Ian
Thanks for the response.
I was on pristiq for 6 weeks at 100mg but it just made anxiety much worse. Was a bit better for depression.
Was on lexapro for 6 weeks also starting at 10mg and working up to 20mg but had the same results as the pristiq.
The MAOI was parnate for 7 days. I felt really hyped up and there was no way I could continue.
I was on nortriptyline for about 2 months at low dose 10mg but didn’t do much and amitriptyline couldn’t go past 30mg because of sedation. Again I wasn’t on this medication very long. Also tried deptran for about a week but stopped due to abnormal aggression. Very strange for me as I’m pretty peaceful.
Regarding paroxetine dose I can only guess that the 10mg is upping my serotonin because of all the increase anxiety/depression (side effects?).
Might try to go to 20mg after talking to my GP.
On another note I’ve seen online that there is a slow release version of paroxetine that might help reduce the start up anxiety. I wonder if anyone has had luck with that vs immediate release?
I really hate the fact that anxiety is a side effect for an anti anxiety medication. Grrr
I will try and stick it out the best I can.
Thanks
John
Ps thanks for the links will check them out tomorrow. 👍
Ok so I just saw my GP and her suggestion was to stick with medication for another 2 weeks till I see my psych. Apparently feeling a little bit worse when starting a med is normal.
I must say that on other medications I would be crawling out of skin by this stage and that is not happening.��
She said I could try and up my dose but could lead to more side effects. In her own words my condition “is above her pay grade” lol.
Not really sure what to do but looks like I’ll be sticking to 10mg as I’m frightened of heightening my anxiety and depression. Thanks
Wish me luck ��
panic_down_under
24-06-21, 10:57
I was on pristiq for 6 weeks at 100mg but it just made anxiety much worse. Was a bit better for depression.
Was on lexapro for 6 weeks also starting at 10mg and working up to 20mg but had the same results as the pristiq.
The MAOI was parnate for 7 days. I felt really hyped up and there was no way I could continue.
I was on nortriptyline for about 2 months at low dose 10mg but didn’t do much and amitriptyline couldn’t go past 30mg because of sedation. Again I wasn’t on this medication very long.
As I suspected you were never on any of these either long enough, or at a high enough dose of some to get a therapeutic response.
I find it 'interesting' that you were prescribed 3 TCAs, but not imipramine (Tofranil) which was the 'gold standard' panic disorder AD for decades before the SSRIs hit the market and bewitched psychiatrists and GPs with promises not all could keep.
Also tried deptran for about a week but stopped due to abnormal aggression. Very strange for me as I’m pretty peaceful.
Very strange indeed as despite the claims doxepin (Deptran) is only a powerful antihistamine, not an antidepressant. If 30mg amitriptyline was too sedating then doxepin should have rendered you comatose. But all these meds can be very unpredictable. It all comes down to how they mesh with individual biology
Regarding paroxetine dose I can only guess that the 10mg is upping my serotonin because of all the increase anxiety/depression (side effects?)
Serotonergic ADs increase serotonin activity within the first hour of the first dose. The fact that this often makes anxiety worse is one of the clues that anxiety and depression aren't caused by too little serotonin as popular mythology claims. Fortunately, after a few weeks bio-feedback mechanisms kick-in to significantly down-regulate its synthesis and expression in areas of the brain that manifest anxiety and the heightened anxiety and other side-effects then usually diminish.
On another note I’ve seen online that there is a slow release version of paroxetine that might help reduce the start up anxiety. I wonder if anyone has had luck with that vs immediate release?
Give it a try if you can get it prescribed, but there's no guarantee that it will reduce the severity of the initial side-effects. If paroxetine proves successful then you should take a slow/extended-release formulation to avoid any potential yo-yo effect as the med enters and drops out of your system.
I really hate the fact that anxiety is a side effect for an anti anxiety medication. Grrr
Who said the gods don't have a sense of humour?! :ohmy:
Not really sure what to do but looks like I’ll be sticking to 10mg as I’m frightened of heightening my anxiety and depression. Thanks
Unfortunately, you need to break eggs to make an omelet. I urge you not to remain on 10mg indefinitely as it will likely cause the med to poop-out.
I really hate the fact that anxiety is a side effect for an anti anxiety medication. Grrr
Who said the gods don't have a sense of humour?! :ohmy:
The gods must be crazy ��
Not really sure what to do but looks like I’ll be sticking to 10mg as I’m frightened of heightening my anxiety and depression. Thanks
Unfortunately, you need to break eggs to make an omelet. I urge you not to remain on 10mg indefinitely as it will likely cause the med to poop-out.
Might try the 20mgs when I have no commitments the next day.
Ive had a horrid run on meds and don’t want to rush this one.
Regards
John
Sorry but I’m still getting the hang of the quote features Ian
On a side note the GP said they don’t prescribe extended release first off because if you have a bad reaction it will be in your system longer? Kind of makes sense I guess.
panic_down_under
25-06-21, 12:10
Ive had a horrid run on meds and don’t want to rush this one.
Unfortunately, having to endure the initial side-effects is something some of us can't avoid. All you can do is treat the side-effects and hunker down until they pass.
Ime, distraction helps. I have a collection of books I was given while in hospital when first prescribed an AD. Reading them got me through some very dark days (mostly my own fault for upping the dose quickly because I wanted to get back to work asap to save my career). When I say 'reading' I don't mean in the way you're, hopefully, reading this. It was more looking at each word in turn without really grasping what the story was about, but it helped divert my attention from the misery. They've served the same purpose a couple of times since when going back onto ADs. Thirty four years later I still can't tell you what most are about. I did promise myself I'd read them when I retired, but 22 years later I still haven't found the time. :ohmy:
Ok so I decided to go to 20mgs last night as everything says that is the minimum therapeutic dose and it’s the weekend and most of Sydney is in a COVID-19 lockdown so should be an easy weekend.
-Side effects to report are nausea after taking pill. I take it with dinner so that helps reduce the nausea.
-Dry mouth for which I use biotene mouth spray.
-Jaw stiffness.
-Sleep disturbance but not quite insomnia so I think that will pass.
-Headaches are worse and have taken paracetamol.
-Increased anxiety which I think is the cause of the headaches. Really don’t want to be reaching for Valium as I’ve been on 2mg for a couple of weeks now and it is by no means a panacea.
Interestingly it hasn’t increased depression so far…(it’s not really better either) Depression and anxiety are a real chicken and the egg situation.
My main concerns are the increasing anxiety and related headaches as I need to show my face at work for a couple of hours on Monday and driving sends my anxiety/panic into the stratosphere! Even just thinking of it.
Distraction techniques I use are couch time and TV but I know I can’t do that forever. Watching Mare of Easttown with the wife at the moment. I also force myself to do a 10 minute walk in the afternoons. And of course reading this forum!
Hope you get around to reading those books Ian. Lol
I wish I get some relief soon but I have remember that this is marathon and not a sprint.
God bless
John
panic_down_under
26-06-21, 12:28
-Side effects to report are nausea after taking pill. I take it with dinner so that helps reduce the nausea.
Nausea may be directly caused by ADs, or by the heightened anxiety they trigger. Ginger and vitamin B6 supplements are often effective.
-Dry mouth for which I use biotene mouth spray.
The Biotene products are usually very effective.
-Headaches are worse and have taken paracetamol.
Paracetamol, aka acetaminophen, is preferred to the NSAIDs as SSRIs are also mild anticoagulants.
-Increased anxiety which I think is the cause of the headaches.
SSRIs and other serotonergic ADs affect blood vessel tone, constriction and dilation, and that is probably the main cause of the headaches.
My main concerns are the increasing anxiety and related headaches as I need to show my face at work for a couple of hours on Monday and driving sends my anxiety/panic into the stratosphere! Even just thinking of it.
While SSRIs may heighten anxiety at the beginning it sounds like it won't be the only, or even main driver.
Hope you get around to reading those books Ian. Lol
I'm having minor surgery early next week so I'm taking a couple of them with me to while away the hours between feasting on hospital food. :ohmy:
Ok so second day at 20mg and headaches much worse. Barely made it down the road for a coffee.
Anxiety just as bad as ever but nausea and dry mouth have disappeared.
Not sure how much more of these headaches I can take as they feed the thought “I’m not getting better”.
Funny thing is 2 weeks into 10mg dose I had some good moments so wondering whether I have to wait another 2 weeks for this dose to settle or maybe I jumped up too early.
Good luck with the day surgery Ian, hope your ailment gets resolved.
John
panic_down_under
27-06-21, 10:28
Ok so second day at 20mg and headaches much worse. Barely made it down the road for a coffee.
Drinking coffee might not be wise atm as it significantly constricts blood vessels, as may SSRIs.
Not sure how much more of these headaches I can take as they feed the thought “I’m not getting better”.
No point in thinking this as it will likely take 5 plus weeks before you're likely to get better.
Funny thing is 2 weeks into 10mg dose I had some good moments so wondering whether I have to wait another 2 weeks for this dose to settle or maybe I jumped up too early.
It may take several weeks for the initial side-effects to diminish. As per an earlier post, paroxetine doses can be increased after 5 days without increasing the severity of side-effects. Delaying the increase won't significantly reduce any spike in side-effects severity.
Good luck with the day surgery Ian, hope your ailment gets resolved.
Thanks. This is the third time I'm having the knee worked on. The first was a failure, probably more because of events immediately after the surgery rather than the op itself, the second was a great success which gave me 20 pain free years so it's a better than 50:50 chance.
Yes I’ve got a dodgy knee with a meniscus tear but I’m getting by with physio at the moment. Might consider surgery if it gets worse down the track.
Took the day off work as I don’t think driving today is such a great idea considering headaches last night were horrendous and it spiked my anxiety. Let’s see what tomorrow brings.
Quick update, headaches still present but not as bad.
Anxiety dipped yesterday and got hopeful but this morning it was back up again.
I’ve heard that anxiety is the last symptom to go when on AD so hopeful i will start getting some relief.
Shouldn’t have had a coffee at 5pm yesterday!
Spoke too soon. 4days at 20mg and TOO many pounding headaches. Going back down to 10mg.
panic_down_under
30-06-21, 11:51
Spoke too soon. 4days at 20mg and TOO many pounding headaches. Going back down to 10mg.
Does your GP know about the headaches and if so what did she recommend?
Does your GP know about the headaches and if so what did she recommend?
I’m seeing psych in 2 weeks.
Have had headaches before but they were related to anxiety.
These are definitely from the medication. Been back at 10mg for 2 days and headaches have reduced.
I take paroxetine with dinner around 7:30pm and get slight headaches around 7:00am in bed.
I wonder if I should be taking it later maybe just before bed or even first thing in the morning?
panic_down_under
01-07-21, 03:21
No guarantees, but it would be definitely worth trying taking at other times of the day.
No guarantees, but it would be definitely worth trying taking at other times of the day.
Thanks! Will take it at bedtime tonight and see how I go.
Sorry to butt in but I just wanted to say that paroxetine has really helped me with my anxiety and PDU really helped with advice on my recent dose increase. I didn't find any benefits until 3+ weeks and it really helped using something to help with the anxiety for the first 4 weeks. The side effects do pass.
Good luck.
Sorry to butt in but I just wanted to say that paroxetine has really helped me with my anxiety and PDU really helped with advice on my recent dose increase. I didn't find any benefits until 3+ weeks and it really helped using something to help with the anxiety for the first 4 weeks. The side effects do pass.
Good luck.
Thanks Catkins, I took my dose just before bed and seemed to have slept better. Still have slight headache and dizziness. Worst of all anxiety/depression still present so am still waiting for breakthrough.
Wish me luck!
Ok so IÂ’m officially at the end of week 3!
Headaches/dizziness were still present last night although I must admit not as bad as one week ago.
Thought IÂ’d challenge myself this morning and drove to work and back. (I didnÂ’t actually work, I just did the drive for exposure therapy)
Although the anxiety is still very present it went better than expected.
The real test will be on Monday when I actually do a few hours work.
This medication journey really is a case of one week at a time. Results donÂ’t come easy but IÂ’m praying for better times ahead.
Looks like this thread is becoming my paroxetine diary.
A few days into week 4 at 10mg and still can’t see any benefits…
Worst of all still got side effects. Namely poor sleep and occasional nightmares. Also a bit of derealisation. Headaches seem to be subsiding. I’m taking Restavit to help with sleep.
Yesterday I felt very depressed.
Managed to get to work today and did half a day work but had to take 2mg Valium. Feel sleepy now but can’t really snooze which is very irritating.
Do I stick with this med or is it just not agreeing with me? Any advice would be appreciated.
PS I am taking medication at bed time but think I should change to taking it in the morning.
I take mine in the morning. I find it's better for me to take it then.
I take mine in the morning. I find it's better for me to take it then.
Thanks Catkins!
Did you ever try taking it at a different time or did you always take it in the morning?
panic_down_under
05-07-21, 13:34
A few days into week 4 at 10mg and still can’t see any benefits…
...Do I stick with this med or is it just not agreeing with me? Any advice would be appreciated.
I wouldn't expect much at 4 weeks, plus you are probably on a sub therapeutic dose which won't consistently activate neurogenesis.
Thanks Catkins!
Did you ever try taking it at a different time or did you always take it in the morning?
TBH I've only taken it at other times when I've forgotten to take it in the morning. I think I may have been told that it was better to take it in the morning - I'm a bit of a stickler for taking things when I'm told.
Also I went straight in on a 20mg dose (this was a long time ago). The first couple of weeks were tough, the first few days were horrendous. But it did get easier with time.
Thanks for the responses PDU and Catkins.
I have a tendency to expect fast results from medications and end up quitting them before they have a chance to work.
Also I am very sensitive to medications and do not understand how others can tolerate such high doses when I struggle on tiny amounts?
I am seeing my psych next Wednesday to discuss my progress. In the meantime I will stick to 10mg and pray the sleep issues resolve themselves…
Thank you again for your help :)
panic_down_under
06-07-21, 13:00
I have a tendency to expect fast results from medications and end up quitting them before they have a chance to work.
There is nothing fast about ADs because of the indirect way they work. Biology works to its own rythm irrespective of our wishes.
Also I am very sensitive to medications and do not understand how others can tolerate such high doses when I struggle on tiny amounts?
Have you considered that not all your symptoms are necessarily caused by the med, but may be at least partly psychological and could well be the major factor?
WiredIncorrectly
06-07-21, 14:31
I'm on 40mg.
Yes they do work. It took me a while to adjust to them. It's advised to not skip doses of this drug too because withdrawal is swift and sharp.
I don't think I have side effects from them anymore. I've been on them probably around 2 years now.
I'm on valium too. I was doing well without them, but life is rocky at the moment so I'm back to taking 3/4 a day.
I'm not sure if this drug causes night sweats, but I have them terrible. I read somewhere they can.
Other than that, I will say it's a good drug that works for me.
Hey PDU I definitely think there is a biological factor to my mental health as well as psychological.
I am also seeing a psychologist and we are working through things together.
Getting back to work full time is a big thing for me as I am still doing half hours and that affects my self esteem.
On a positive I went to work today for a few hours and no Valium or panadol was required so small victory.
I'm on 40mg.
Yes they do work. It took me a while to adjust to them. It's advised to not skip doses of this drug too because withdrawal is swift and sharp.
I don't think I have side effects from them anymore. I've been on them probably around 2 years now.
I'm on valium too. I was doing well without them, but life is rocky at the moment so I'm back to taking 3/4 a day.
I'm not sure if this drug causes night sweats, but I have them terrible. I read somewhere they can.
Other than that, I will say it's a good drug that works for me.
Hello Wired and thanks for the input.
I never skip doses and have curbed my alcohol intake to give the meds a chance to work.
I have not had night sweats but years ago I was on Pristiq and that caused a lot of sweating for the first few months but I adjusted to it. Also, I came off Pristiq with very little trouble but have heard from others that the withdrawal is brutal so we are all different I guess.
Side effects I still have are early waking when I sleep, slight headache, a little bit of teeth grinding and lack of interest in sex. I think/hope these will subside in the coming weeks and months.
One thing I like about paroxetine is that it is not overly stimulating. Quite a few medications I tried sent me “manic” for lack of a better word.
I also like that from my current dose of 10mg I have room to move as some people take 20, 30, 40, 50, 60mg. So if it works for me I can potentially be on it for a long time with adjustments. My psychiatrist changed my appointment to early August and I wanted to talk to her about getting the extended release version of paroxetine but I guess that will have to wait.
panic_down_under
07-07-21, 12:57
I'm not sure if this drug causes night sweats, but I have them terrible. I read somewhere they can
It probably is the paroxetine, James. It is a relative common side-effect of all serotonergic ADs with paroxetine and sertraline being the most likely SSRIs to do so. In addition to stuffing up our brains, serotonin also affects the sympathetic nervous system which regulates sweating, determines blood vessel tone and affects the hypothalamus which, among other things, is the thermostat which sets the body's core temperature. :ohmy:
panic_down_under
07-07-21, 13:06
Side effects I still have are early waking when I sleep, slight headache, a little bit of teeth grinding and lack of interest in sex. I think/hope these will subside in the coming weeks and months.
All bar the last one will likely diminish as the body adjusts, but there are ways (http://www.nomorepanic.co.uk/showpost.php?p=1695131&postcount=7) of minimising the last one too.
WiredIncorrectly
07-07-21, 14:11
It probably is the paroxetine, James. It is a relative common side-effect of all serotonergic ADs with paroxetine and sertraline being the most likely SSRIs to do so. In addition to stuffing up our brains, serotonin also affects the sympathetic nervous system which regulates sweating, determines blood vessel tone and affects the hypothalamus which, among other things, is the thermostat which sets the body's core temperature. :ohmy:
That explains why I have problems sweating. Literally just put up a post about it.
WiredIncorrectly
07-07-21, 14:13
a little bit of teeth grinding and lack of interest in sex.
Yes, this. My sex drive doesn't return until I accidentally miss a dose.
Hi Peeps,
To be honest the sexual side effects are the least of my problems right now. I tested “it” and it still works so I am not to worried about that.
Right now my main concern is the insomnia/sleep issues. Part of this is your run of the mill stress and over thinking but there is a chemical component to it as well.
I worry the medication is going to make me agitated as other meds have had this effect of lifting depression but INCREASING anxiety or at the very least not helping with the anxiety.
I will be using some Restavit (Doxylamine) tonight as I cannot function on 4 or 5 hours sleep.
medication to treat medication argh
panic_down_under
08-07-21, 13:38
I worry the medication is going to make me agitated as other meds have had this effect of lifting depression but INCREASING anxiety or at the very least not helping with the anxiety.
Don't go talking yourself into a side-effect, John. Anxious minds are very capable of creating our worst fears if given half a chance.
You were never on an AD long enough, or on a high enough dose to get a positive result. All ADs may increase anxiety levels initially. It if occurs there are ways of minimising the anxiety until paroxetine kicks-in.
I will be using some Restavit (Doxylamine) tonight as I cannot function on 4 or 5 hours sleep.
Not one I've come across, but the sedating antihistamines are usually effective for SSRI induced insomnia. It usually doesn't last long.
Don't go talking yourself into a side-effect, John. Anxious minds are very capable of creating our worst fears if given half a chance.
You were never on an AD long enough, or on a high enough dose to get a positive result. All ADs may increase anxiety levels initially. It if occurs there are ways of minimising the anxiety until paroxetine kicks-in.
Not one I've come across, but the sedating antihistamines are usually effective for SSRI induced insomnia. It usually doesn't last long.
Thanks Ian
Lol I am realising that I do tend to overthink things. Four long years of panic in situations like driving in traffic or social settings where I cannot move freely have become habitual. I cannot expect to be rid of these feelings overnight. They will require re-learning.
I took the antihistamine last night and slept well thank God. I might try and go without it tonight and see how I sleep.
There were some positive feelings this morning but still burning through a lot of anxious energy.
I will still stick with the 10mg of paroxetine at this stage for at least another week or two as it seems to be moving in the right direction. I have been on it one month exactly now and let me say it was not an easy month.
panic_down_under
09-07-21, 11:43
I took the antihistamine last night and slept well thank God. I might try and go without it tonight and see how I sleep.
Cool. Tolerance to antihistamine sedation tends to build slowly, much slower than for benzodiazepines, but it does happen so missing a day, or three occasionally is a good idea.
I will still stick with the 10mg of paroxetine at this stage for at least another week or two as it seems to be moving in the right direction. I have been on it one month exactly now and let me say it was not an easy month.
Okay, but I'd be wary about staying on 10mg for an extended period.
Ian
Thanks for the info Ian.
Yesterday I had the best day I have had for while. I was productive and fairly positive.
Therefor last night I decided not to take the antihistamine and had a bad nights sleep.
Today I feel absolutely lousy. Headaches, anxiety, low mood etc. I will be taking the sleeping aid again tonight and see how I feel tomorrow. To be honest if I could sleep properly I think that would go a long way towards getting me over the line.
Can I take the antihistamines medium term? I mean like for a month or so.
I have read that paroxetine stuffs up your sleep and that definitely seems to be the case with me. Very frustrating.
Regards John
panic_down_under
10-07-21, 13:01
Can I take the antihistamines medium term? I mean like for a month or so.
It shouldn't be a problem, John, but I suggest you halve the dose for a week or so when you come off it if you've been taking it most nights.
I have read that paroxetine stuffs up your sleep and that definitely seems to be the case with me. Very frustrating.
All SSRIs and SNRIs may trigger insomnia. So much so that the AD trazodone is either the most, or second most prescribed AD despite being rarely prescribed for anxiety, or depression. It's main use these days is alleviating SSRI/SNRI induced insomnia.
Ok so I slept well last night with the Restavit and feel slightly more positive depression wise.
The headaches are still present but I had headaches before starting paroxetine so I cannot blame the medication 100% for that. Also anxiety causes headaches for me.
The anxiety does not seem to be abating at all unfortunately. I wish my Dr had given me 10mg pills as I think when I split the 20mg pills I am getting a bigger piece and a smaller piece and might be yo-yoing?
panic_down_under
11-07-21, 02:34
The anxiety does not seem to be abating at all unfortunately.
Way too early and probably too low a dose to be doing much.
I wish my Dr had given me 10mg pills as I think when I split the 20mg pills I am getting a bigger piece and a smaller piece and might be yo-yoing?
Pill-cutters are more accurate, but I doubt the small dose variation is having much impact.
Quick up date.
Have been using the Restavit for sleep and still on 10mg paroxetine and have had a better couple of days.
Not cured by any stretch of the imagination but seem to heading in the right direction.
Went to work with very little stress and even driving did not arouse my panic.
I am not ready for bridges and tunnels yet but praying things will continue to improve.
So after two good days have crashed again!
Had a crap sleep last night and barely scraped through half a day at work. Unfortunately the antihistamine did not do much last night.
When I have that broken sleep the anxiety, depression and headaches all return with a vengeance.
How long does this paroxetine induced insomnia last? I am at 4 1/2 weeks now.
Thank you in advance John
panic_down_under
13-07-21, 12:15
.How long does this paroxetine induced insomnia last?
That is a 'how long is a piece of string' question that can only be answered with, "it depends", John. :ohmy:
Plus, it may not all be down to the med. Anxiety is probably also contributing and could even be the main factor.
That is a 'how long is a piece of string' question that can only be answered with, "it depends", John. :ohmy:
Plus, it may not all be down to the med. Anxiety is probably also contributing and could even be the main factor.
I rarely had more than a couple bad sleeps per week before starting this medication. Now it is pretty much constant. The chemist said melatonin might help but I need a prescription from my GP and I am seeing her on Monday afternoon. Should I ask for trazadone? Will it compliment the paroxetine?
I want to up this medication to 20mg but I am worried it will make the sleep issues worse.
The real kick in the guts is that all Sunday and most of Monday (at work) I felt almost normal again but it pooped out just as quick as it started.
panic_down_under
14-07-21, 09:48
I rarely had more than a couple bad sleeps per week before starting this medication. Now it is pretty much constant. The chemist said melatonin might help but I need a prescription from my GP and I am seeing her on Monday afternoon. Should I ask for trazadone? Will it compliment the paroxetine?
Why not ask for both? Melatonin is a metabolite of serotonin so might not be as effective at the moment with the heightened serotonin activity. But is may be more effective later as serotonin synthesis and expression is down-regulated.
Trazodone is, depending on which market report is consulted, either the most, or second most prescribed AD, despite not being prescribed for anxiety, or depression much. It owes its popularity to SSRI/SNRI induced insomnia.
I want to up this medication to 20mg but I am worried it will make the sleep issues worse.
It is just as likely to if you delay the increase for months.
So a quick update.
This week I have managed to do more than I have done for a while so there must be some positives. I think I will feel better when I see my pay check. :)
Today is Saturday and I have a bad headache which started yesterday afternoon.
I have been trying to up my dosage ever so slightly the last 3 days by weighing the pills on some digital jewellers scales and increasing dose by one hundredth of a gram per day. I have calculated that it will take 12 days to go from 10mg to 20mg. (Pill weighs 0.25g)
Sleep issues are no better but no worse.
Sexual side effects have disappeared.
No nausea.
No appetite in the morning but hungry at night.
Mood still fluctuates.
Anxiety maybe 10 percent better.
Still grinding teeth occasionally.
Headaches are pretty bad. I am living off Panadol and Nurofen. :(
I even took 2mg Valium last night in the hope it would somehow help my headache!
Anyway that is it for today. Keep you posted.
With the no appetite in the morning, I'm very much like that. I struggle in the mornings to eat but as the day goes on my appetite improves. I believe it's connected to the anxiety rather than the pills. My anxiety is always highest in the mornings.
panic_down_under
17-07-21, 09:26
I even took 2mg Valium last night in the hope it would somehow help my headache!
Did it?
Did it?
No but I slept well
Think I will switch to taking the paroxetine in the mornings.
Had another really bad nights sleep last night and barley dragged myself to work for half a day.
I think it at the start the pills were sedating but are now stimulating. Can this happen?
Just saw my GP regarding insomnia and got prescribed melatonin. She wants me to take 10mg tonight and see how I go.
Trazodone is not available in Australia.
panic_down_under
19-07-21, 12:23
Just saw my GP regarding insomnia and got prescribed melatonin. She wants me to take 10mg tonight and see how I go.
Please let me know how it goes.
Trazodone is not available in Australia.
Not on the PBS, but doctors can prescribe it via a compounding pharmacy. Veterinarians can and do prescribe it fairly frequently to ease anxiety. Unfortunately, the best of the alternatives, hydroxyzine isn't available on the PBS either as they regard the hydroxyzine metabolite cetirizine a better antihistamine specifically because it isn't sedating.
Another antihistamine, diphenhydramine, which is the active ingredient in some versions of Benadryl, is available over-the-counter at pharmacies in Unisom Sleepgel, Snuzaid Gel and Snuzaid Tab. It is also the active ingredient in some liquid cold and cough remedies and decongestants, however, these may also contain the opioid analogue dextromethorphan as the cough suppressant which theoretically could trigger serotonin syndrome when taken with a SSRI. Whether remedies actually contain enough to cause an issue I can't say though my guess is they don't, however, I'd give them a miss anyway.
I've used melatonin before. Had to buy it from the US on the internet as it's not available over here. I thought it was quite good. I could get a solid 5 hours before I woke up and then I could go back to sleep and if I wasn't very anxious would sleep 8 hours. Only thing I found was that (and this is only my opinion) was that after a while it became less effective. So I found it best not to use for long periods. I would use it again.
panic_down_under
20-07-21, 00:19
Only thing I found was that (and this is only my opinion) was that after a while it became less effective.
This seems true with all insomnia aids to varying degrees. Tolerance to benzodiazepines and the related 'Z' hypnotics can occur within a few weeks. It usually takes considerably longer with the antihistamines and I'm not sure about melatonin. The evidence is contradictory.
I decided to take the day off work considering I am changing medication timing.
I skipped my nighttime dose of paroxetine and took it this morning instead.
Last night I took 4mg of melatonin an hour or so before bedtime. I got to sleep ok but woke up about four hours later and had broken sleep the rest of the night.
This is my main problem! I can get to sleep ok but once I wake up to go to the toilet I have trouble falling asleep again.
I will give this new regime another week or two but if it does not improve I will have to give up/switch antidepressants.
I am currently approaching the end of week six.
Thanks for the input guys and gals.
panic_down_under
20-07-21, 12:49
I decided to take the day off work considering I am changing medication timing.
I skipped my nighttime dose of paroxetine and took it this morning instead.
How did that go, John? Any increase in side-effects severity?
I will give this new regime another week or two but if it does not improve I will have to give up/switch antidepressants.
Citalopram is one of the two SSRIs considered to be least likely to trigger insomnia, but the other is paroxetine, so there are no guarantees. It comes down to how well a med meshes with individual biology. One of the TCAs may be a better bet.
How is the slow dose increase going?
How did that go, John? Any increase in side-effects severity?
Hi Ian. To be honest it doesn’t seem any better or worse.
Citalopram is one of the two SSRIs considered to be least likely to trigger insomnia, but the other is paroxetine, so there are no guarantees. It comes down to how well a med meshes with individual biology. One of the TCAs may be a better bet.
I took 2mg melatonin last night and slept well. But that might also be because I do not work Wednesdays.
How is the slow dose increase going?
Due to the insomnia and crushing headaches I have gone back to 10mg. I know 20mg is meant to be the therapeutic level but have read of people being on lower doses successfully for years.
I am really angry that all I seem to have gotten from this medication are side effects. Namely headaches and insomnia. I will admit I had a couple of good days but that was about it.
Soon I will have been on it for 6 weeks. Do I continue with it for a bit longer or am I flogging a dead horse? I mean will there be some magical moment at the 2 month mark were I will say that this has all been worth it?
Still getting the hang of the reply with quote thing sorry.
panic_down_under
21-07-21, 11:31
Due to the insomnia and crushing headaches I have gone back to 10mg.
I doubt the tiny dose increases would be causing this.
I know 20mg is meant to be the therapeutic level but have read of people being on lower doses successfully for years.
There are always a few exceptions that prove the rule, but a lot of the time they are folk who have gone into remission and all too often when their disorder returns fail to get a response from the med even at its maximum dose.
I am really angry that all I seem to have gotten from this medication are side effects. Namely headaches and insomnia. I will admit I had a couple of good days but that was about it.
It is still early days and you are on a dose that may be unable to initiate the therapeutic response. For most ADs the dose needs to be high enough to block 80% (https://doi.org/10.1176/appi.ajp.161.5.826) of the serotonin transporters (SERT) to initiate neurogenesis.
Soon I will have been on it for 6 weeks. Do I continue with it for a bit longer or am I flogging a dead horse? I mean will there be some magical moment at the 2 month mark were I will say that this has all been worth it?
I can't say, John. Only time will tell.
Thanks Ian
Striatal Serotonin Transporter (5-HTT) Occupancy at my dose looks like 70 percent going off the chart. (Hopefully in my case it is higher)
Also the blood plasma level difference from 10mg to 20mg are negligible but for me personally the side effects going from 10mg to 20mg are unbearable.
So it looks like I have no choice but to tolerate what I can for now and pray for the best.
Regards
John
panic_down_under
22-07-21, 11:43
So it looks like I have no choice but to tolerate what I can for now and pray for the best.
Is therapy an option, John?
Is therapy an option, John?
I have a psychologist I see every month or two.
She helped me at the start but lately I am not getting much help out of her. We seem to be talking about the same things a lot.
I feel the CBT only gets me treading water but nowhere close to remission. That is why I am pinning hope on medication.
To be honest I think a combination of counselling, CBT and medication is what works best for me. But sometimes you do need to go over things time and time again before you feel the benefit. 14 years of managing my anxiety and it came to kick me up the arse this year again. So back into counselling and there are still things that were lurking in my brain that negatively impact on me. I would stay stick with the counselling as well as trying medication.
panic_down_under
23-07-21, 00:56
I have a psychologist I see every month or two.
She helped me at the start but lately I am not getting much help out of her. We seem to be talking about the same things a lot.
I feel the CBT only gets me treading water but nowhere close to remission
Are you actually doing CBT? It, and the related REBT and mindfulness therapies, isn't just dropping in for a chat with the therapist every once in a while about problems, but a time limited (typically <=12 sessions), goal oriented approach involving learning how to reframe anxiety (also depression), challenging the thought patterns and habits that encourage it and devising coping strategies for when it flares. See: All About Cognitive Behavioral Therapy (CBT) (https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy)
Thanks Catkins,
Sorry to hear your anxiety stirred up again. I really hope you are feeling better.
Recovery is multi faceted although we all wish for that elusive silver bullet. :)
I am at six weeks with the meds. Sleep has improved since I changed to morning dose. Anxiety and headaches which go hand in hand still ever present.
Go Australia in Tokyo 2020/2021 :-)
Hi Ian,
I use thought challenging everyday. And to a large extent it works.
However when I am in the throws of a full blown anxiety attack it has limited effectiveness.
I hope to get some relief from the medication to make more room for the talk therapy to work.
Honestly I know that driving in traffic on a main road is no reason to panic. But when I find myself in that situation rational thought disappears and gives rise to anxiety. I do not know why but it happens again and again. You would think it would be gone by now (4years). I guess I am what Claire Weekes called “sensitised”. Sometimes I am in the same situation and it does not cause any panic at all. Bizarre.
panic_down_under
24-07-21, 01:02
Honestly I know that driving in traffic on a main road is no reason to panic.
Did you once have a panic attack on that road, or on another one, John?
The second of the 3 PAs that propelled me into panic disorder occurred while waiting for oncoming traffic to clear so I could compete a right hand turn on a major intersection during the morning peak. I felt the PA building as I approached the intersection and it really kicked in just as I stopped in the middle with the major symptom dimmed, blurred vision. I can't tell you how I got out of it, but I knew I had to before the lights changed because some idiot was almost certainly going to take off and clean me up. I moved interstate soon after so didn't have to drive through that intersection again, but I did take side streets for a while to avoid light controlled intersections.
Then in 2010 I was back there after 23 years and while I didn't have a full blown PA, my anxiety levels did shoot up dramatically even before I consciously remembered what had happened there all those years ago.
Long story short I was in a situation where I had to drive over the Sydney Harbour Bridge or the Harbour Tunnel to get to work daily. I had no trouble doing the commute except for normal rush hour annoyance.
Work was my own business that was failing and I realised that financially I was going to take a big hit. Worse still I had 2 years left on a lease I could not get out of.
The icing on the cake was that I made this realisation just as my son was born.
So depression about losing a bunch of cash, not enjoying my newborn AND being stuck in this situation for another 24 months broke me mentally. I do not know how I made it through.
This led to massive panic attacks especially when alone in the car and intrusive thoughts. I got to a point towards the end where I basically gave up going to work and wrapped things up a few months early.
Then I took almost a year to recover to a point where I could work 3 days a week in a pretty easy job. Things were looking better. Still anxious about driving and well just existing but I was better. I was trying different medications every few months but life was ok even without them.
This January my family (me, wife, son, sister in law) all drove up to the central coast for a friends birthday.
On the way back home a driver on the other side of the road must of being playing with his phone or distracted in some way. He drove straight in front of us causing a bad head on collision. I was bruised up pretty bad but otherwise ok. My son was bruised up too and psychologically in quite a state but ok. My wife who was driving shattered here heal bone and required surgery. Her recovery will take years. My sister in law was airlifted to hospital with suspected spinal injuries. She had a bunch of broken bones but will recover with time.
So for the next few months after the accident I was stuck looking after my family who could not fend for themselves whilst being pretty banged up myself. Depression and anxiety and intrusive thoughts kicked in AGAIN.
This led me back to psychiatrist to see if I could get some relief.
So here I am. Paroxetine week 6, no relief.
Thanks for listening Ian.
Oh heck, you've had an awful time. Really hope things improve for you.
Oh heck, you've had an awful time. Really hope things improve for you.
Thanks Catkins, I know things will get better. I just need more time.
Still no action on the paroxetine front. I am fighting a sinus infection at the moment so I think that is not helping my state of mind…
Really hope the nocturnal awakenings side effects go away soon.
Think I will take a clonazepam tonight as I had a bad sleep last night and two bad sleeps in a row knocks me out.
UPDATE:
I am still taking 10mg paroxetine every morning. It will be week 7 tomorrow.
Last 3 days I have added 1/4 teaspoon of inositol 2 or 3 times daily to my schedule.
Improvements have been staggering.
Yesterday I drove to my mothers place to help her put up a mirror and on the way home something inside me was telling me to try the freeway instead of the usual “safe” route. (I have not gone that way in over a year). I did it with panic but it did not overwhelm me like usual.
Today I went to work and took the main roads which involve big scary bridges. Again I felt panic sensations in my body but they did not disable me like usual.
I have also felt more chatty lately.
I still get headaches although not as severe and the paroxetine is still getting me up at 3am for an hour where I am wide awake. I also still get the teeth grinding.
Is this the paroxetine FINALLY kicking in or the inositol doing something positive?
Any help would be appreciated.
Thank you
John
It could be, although 10mg is quite a low dose.
Tbh it doesn't matter what the cause is, if you're starting to feel a little better it's really good.
You'll probably still have ups and downs, so if you have a crappy day don't beat yourself up.
Hi Catkins,
Thanks for the advice.
I know I am still not 100% but it seems I just carry the anxiety with me more now rather than fight it. The olympics are a great distraction!
I think being down for so long I need to retrain myself to what normal feels like if that makes sense.
Because of an ongoing Covid lockdown in my part of the world I have yet to see my psych to discuss my progress. She offers video sessions but I keep differing my appointment until I can get a face to face. (I do not like Zoom/Skype sessions)
I could bet you she will say increase the dose :-)
John
It makes so total sense. When I get really anxious I feel like my body forgets how to relax and has to relearn how to do it. Hence I do yoga twice a week, do guided meditation, have a massage once a month. Plus the medication.
Also having CBT (on the phone) and speaking to a counsellor (which is on zoom, which I don't like as much as in person, but it was more important for me to speak to someone than wait).
You'll get there, just keep trying and eventually things will feel more natural and 'normal'.
Thanks Catkins
I take short walk every afternoon and then follow it up with a guided meditation to help me relax.
I still have some side effects from the medication. Namely disturbed sleep and headaches. I find myself alternating between paracetamol and ibuprofen every day!
I am heading into week 8 at the moment. Did you have bad headaches for the first few months? Did they go away or how did you manage them?
Regards
John
To be honest, I often get headache with anxiety so it's hard to tell if it was the medication or my anxiety.
The main thing I noticed was a bit of an increase in anxiety levels, but to be honest that passed quite quickly. I think I was quite lucky.
Yes I get bad headaches from anxiety too but the current headaches seem different and related to the medication.
The insomnia really sucks. I am tired but cannot sleep. I have been on the melatonin 2-4mg for a week or two but to be honest I think the antihistamine worked better. Clonazepam works great but I do not want to be taking a benzo every night. This is a reason I am hesitant to go to 20mg of paroxetine.
I believe the insomnia might be the last big hurdle to my recovery.
Has anyone found a way to deal with paroxetine insomnia effectively?
One more thing that has crept in the last few days is fatigue/sleepiness during the day. Last night I slept ok with half a Restavit. I woke up and went for a half an hour walk then had a large coffee and 3 or 4 hours later I was nodding off on the couch. Feeling a bit apathetic.
Tomorrow will be 8 weeks on this medication…
To be honest you could just be worn out, you've had a long period of stress and anxiety. Your mind and body could well be just worn out. One night/week of good sleep won't make up for that.
Be kind to yourself. Rest if you need to. I'd try not to sleep during the day - I find it doesn't really help me.
Thanks Catkins you might be right. I have been smashed with stress lately.
Paroxetine 10mg update after 2 months…
Pros:
Less anxiety
Less panic
Less deep depression
Got me doing things that used to freak me out
Cons:
Insomnia (slightly better but still present)
Random headaches everyday
Emotional blunting
Fatigue
Drugged feeling
So it looks like paroxetine has had some positives but the downside is that it appears blunt any happy feelings as well. I guess you could use the word zombie to describe its effects on me. Not happy or sad, just existing. I refuse to settle for this.
I am speaking to my psych in two days and feel I have given this medication a good go but it might not be a good match for me. Upping the dose is out of the question due to side effects.
I will ask her if I should stick it out a little longer at current or lower dose, add something else to the mix or change medications.
I remember trying lexapro years ago and from memory the side effects were nowhere near as bad as this. I think the reason it might not have “worked” was because I was in a really terrible situation at the time and I only gave it about 6 or 7 weeks. From memory it worked better for depression than anxiety.
I cannot handle really stimulating meds like Effexor or Wellbutrin.
I welcome any input you guys might have from your experiences.
Regards
John
I think escitalopram/lexapro is an effective med and it may be worth a try if your psych decides on a change. I couldn't handle paroxetine at all and have problems with the activating meds like you.
See what your psych says and you can decide on what's the best way forward..
I think escitalopram/lexapro is an effective med and it may be worth a try if your psych decides on a change. I couldn't handle paroxetine at all and have problems with the activating meds like you.
See what your psych says and you can decide on what's the best way forward..
Thanks pulisa,
I have read that lexapro is middle of the road with prozac being the most activating and paroxetine the most sedating SSRI.
How did paroxetine effect you? Insomnia and headaches?
John
panic_down_under
08-08-21, 07:13
I am speaking to my psych in two days and feel I have given this medication a good go but it might not be a good match for me. Upping the dose is out of the question due to side effects.
I will ask her if I should stick it out a little longer at current or lower dose, add something else to the mix or change medications.
While I suspect the side-effects have more to do with anxiety than chemistry I don't see the point in staying on a med you can't tolerate at an effective dose, or of supplementing it with something else in the hope things improve. Better to cut you losses and move on to something else that might do the job.
I remember trying lexapro years ago and from memory the side effects were nowhere near as bad as this. I think the reason it might not have “worked” was because I was in a really terrible situation at the time and I only gave it about 6 or 7 weeks. From memory it worked better for depression than anxiety.
Then it, or maybe citalopram might be worth revisiting, John.
Thanks pulisa,
I have read that lexapro is middle of the road with prozac being the most activating and paroxetine the most sedating SSRI.
How did paroxetine effect you? Insomnia and headaches?
John
It actually got me admitted to a psychiatric hospital as I had such terrible agitation, John. So for me it was the opposite to sedating! Never again!!
It actually got me admitted to a psychiatric hospital as I had such terrible agitation, John. So for me it was the opposite to sedating! Never again!!
Sorry to hear. These meds really work so differently for different people. Valium was my best friend for the first month when starting paroxetine so I guess it agitated me as well. At the moment I am taking OTC pain killers for the headaches pretty much daily :-(
It actually got me admitted to a psychiatric hospital as I had such terrible agitation, John. So for me it was the opposite to sedating! Never again!!
I was the same with Prozac. I couldn't sit still, my legs twitched all the time, anxiety through the roof etc. It was horrendous. I ended up getting admitted too and they took me straight off it and put me on paroxetine, I've been on it at various dosages since. It seems to work OK for me (mostly - until I had to up the dose this time), I'm 'never again' with prozac.
Ok so I spoke to my psych and she wants me to stick to the 10mg paroxetine every morning as there has been some benefits.
I mentioned my failed attempts to go to 20mg and she said that I am likely a slow metaboliser meaning I get more of an effect out of a lower dose of medication. There should really be a test for this rather than trial and error.
I also mentioned the insomnia and she said one in ten people on SSRIs will experience this. As for the headaches she thinks they may be migraines and not medication related. Who knows. So now she has added 10mg of amitriptyline to be taken half an hour before bedtime. This should have the double effect of putting me to sleep and reducing headache frequency.
Wish me luck people :-)
I know people who swear by amitriptyline. It's definitely worth trying.
I know people who swear by amitriptyline. It's definitely worth trying.
Thanks Catkins
I am in a covid lockdown for the next 10 days because I have been deemed a close contact of a confirmed case so it is a good time to get over any initial amitriptyline start up “stuff” before going back to work. :-)
Ps I have already tested negative once so I am not too worried about having covid. My wife on the other hand is petrified;-)
The amitriptyline will knock you out if nothing else!
Less is certainly more effective for me re meds dosage. Maybe I'm a "slow metaboliser" too.
Sorry to hear that you have to self-isolate but you're right..It's the ideal time to test out the amitriptyline. I actually cut the tablet in half due to my "history" and still found 5mg put me to sleep! Hope it helps with your headaches/migraines?
Thanks pulisa
I took the amitriptyline last night and it certainly helped me sleep. Very groggy this afternoon but boredom might be contributing to that.
Still have a headache but I have read it takes time to be effective against migraines. Typically 4-6 weeks to do anything for pain relief so I will be sticking with Panadol in the meantime.
Will keep you posted.
So I have been taking the 10mg amitriptyline at night for 4 days now.
First night slept well but felt groggy the next day.
Second night slept like a baby and had a good day.
Third and fourth nights the medication seems to have lost any effectiveness for sleep. Also noticed more teeth grinding and more frequent nocturnal awakenings.
Looks like the amitriptyline is not as effective as the antihistamine. :-(
panic_down_under
13-08-21, 12:54
Third and fourth nights the medication seems to have lost any effectiveness for sleep. Also noticed more teeth grinding and more frequent nocturnal awakenings.
That may improve as plasma levels build. Is it having any effect on the headaches?
Looks like the amitriptyline is not as effective as the antihistamine. :-(
It is a fairly potent antihistamine, but not as potent as mirtazapine, doxepin, etc.
Hey PDU
Hope you have been well.
Amitriptyline has had no effect on headaches unfortunately. I am fighting the urge to take panadol as I find I am using it daily.
Teeth grinding has definitely gotten worse since starting the tricyclic. Sleep has actually gotten worse too except for that one great sleep on day two. I can feel it starting to activate me rather than sedate. Oh and the usual difficulty peeing and dizziness upon standing.
Basically I need a paroxetine type medication that does not cause insomnia or headaches and I would be fine. Is that too much to ask ;-)
Regards
John
panic_down_under
14-08-21, 12:13
Hope you have been well.
I'm doing okay for an old fart. Had my second AZ vaccine yesterday which has me feeling very tired. I had no side-effects from the first one, didn't even feel it going in, but it is making up for that now.
Amitriptyline has had no effect on headaches unfortunately. I am fighting the urge to take panadol as I find I am using it daily.
Provided you're not exceeding the maximum daily paracetamol dose you should be okay, John. If you're concerned about the liver you could take n-acetylcysteine (NAC) supplements. It is given intravenously to protect the liver following paracetamol O.D..There is some evidence NAC eases anxiety too, especially OCD, though I can't say whether it has helped me because my PD was well controlled before I began taking it after lung surgery (it reduces fluid build up).
Teeth grinding has definitely gotten worse since starting the tricyclic. Sleep has actually gotten worse too except for that one great sleep on day two. I can feel it starting to activate me rather than sedate.
Which is the opposite of what it apparently did when you were on 30mg which begs the question is it the amitriptyline, or the combination.
Basically I need a paroxetine type medication that does not cause insomnia or headaches and I would be fine. Is that too much to ask ;-)
You apparently didn't have either side-effect while on escitalopram (Lexapro) at a high dose so maybe it is worth revisiting for longer than the 6 weeks you gave it before.
Lol! I look forward to being an old fart myself someday ;-) I get my first covid shot later this month. I have two days left of home isolation and although it has been relaxing it has not been good for my exposure therapy.
I had smashing headaches all day yesterday but I am trying not to use pain medication for a while because I have read that you can experience rebound headaches.
I stopped the amitriptyline two days ago. Yes, the combination was activating me. Also the dizziness upon standing and difficulty peeing was not tolerable. (It is funny how we forget the side effects.)
Actually slept well last night without taking anything.
I think revisiting the lexapro is a good idea but I am VERY frightened about starting from scratch. I will wait till home isolation ends and work re opens and some normalcy returns to my life before I make any decisions. I was actually doing much better before this covid outbreak at work stuffed up my routine.
As always stay safe and thanks for the input mate.
John
I take 5mg lexapro, John..I have a diagnosis of agitated depression and can't take high dose SSRIs. I find it helps me and I didn't have any side effects on start up. Sometimes less is more if you know what I mean?
panic_down_under
15-08-21, 09:04
I think revisiting the lexapro is a good idea but I am VERY frightened about starting from scratch.
You won't be starting from scratch as you'll retain any accrued benefits from the paroxetine when you switch to escitalopram. Overnight switches between SSRIs at equivalent doses is usually straightforward. A potential issue may be that paroxetine has the shortest half-life of the SSRIs while escitalopram has the second longest so there might be a dip in plasma levels for a few days, but how much of a problem this will be given the low paroxetine dose is debatable.
Hi folks,
I am having a telephone appointment with my psych next Thursday to discuss my progress. I usually do not do virtual meetings but considering the on going lockdowns in Sydney I have no choice.
I am currently in week 10 on the paroxetine 10mg.
Although not perfect my sleep has improved and I am no longer taking sleeping meds.
Headaches still persist randomly, sometimes they are intense and other times manageable.
Fatigue is still present but this might be due to lingering depression/anxiety.
Mood is ok but sometimes flat.
I come out of 14 days isolation tomorrow so hopefully things improve by the time I talk to my psych.
Will keep you posted.
Hi all
Currently at the end of week 10.
Insomnia is no longer a problem and I am sleeping well. Headaches are still hanging around as is jaw clenching.
Worst thing is agitation has been steadily increasing the last few days. I think the amitriptyline that I only took for four days at a low dose might have screwed things up or perhaps as I get the full effect of the paroxetine my body is not agreeing with it.
I have not used benzos for weeks but now feel tempted to take one.
Still one week until I speak to my psych and hope this feeling goes away but if it does not I will be switching meds.
John
I find that agitation is the worst symptom of all this. From my own experience I've found that lexapro helps to take the edge off.
Maybe it would be a good idea to take a benzo now and see if it makes a difference? Obviously benzos aren't for the long term but just to help you get through to Thursday? The jaw clenching will be causing the headaches.
panic_down_under
20-08-21, 11:50
Headaches are still hanging around as is jaw clenching.
Is thew jaw clenching a recent thing, or something that's been occurring for a while, John?
Worst thing is agitation has been steadily increasing the last few days. I think the amitriptyline that I only took for four days at a low dose might have screwed things up or perhaps as I get the full effect of the paroxetine my body is not agreeing with it.
I can't see how amitriptyline could be having an ongoing effect, and agitation tends to begin very early on. I suspect it is more the disorder than the med.
The jaw clenching has been going on for a while so I cannot really blame the medication. I always have chewing gum lying around for when it gets bad.
The agitation however has been ramping up for many days now and feels DIFFERENT to the anxiety/panic that I had to begin with. I had to take 0.25mg clonazepam yesterday. (Valium did nothing)
I am cutting down to 5mg paroxetine until I see my psych as I cannot tolerate agitation and it definitely feels medication induced. Headaches still ever present also. Maybe 5mg might be the dose for me considering how sensitive I am to drugs.
If not what is next? Lexapro? No medication? Do not want to do tricyclics again except as a last resort due to the orthostatic hypotension and difficulty going to the toilet.
Really feel stuck at the moment.
Less is definitely more for me re psych medication. Agitation is a very different ballgame to anxiety/panic.
I think you're doing the right thing re the paroxetine. PDU will no doubt disagree but agitation is unbearable and if the clonapezam takes the edge off then take it when necessary. You've been prescribed it for a reason.
Less is definitely more for me re psych medication. Agitation is a very different ballgame to anxiety/panic.
I think you're doing the right thing re the paroxetine. PDU will no doubt disagree but agitation is unbearable and if the clonapezam takes the edge off then take it when necessary. You've been prescribed it for a reason.
Thanks for the response pulisa
Yes agitation is very different from anxiety and panic. It follows you around even in settings that normally do not induce any anxiety at all.
I am prepared for my brain to start doing somersaults over the next few days as it adjusts to the lower dose.
panic_down_under
21-08-21, 12:31
If not what is next? Lexapro? No medication? Do not want to do tricyclics again except as a last resort due to the orthostatic hypotension and difficulty going to the toilet.
The cognitive/behavioural/mindfulness therapies would definitely be worth a shot, John.
The cognitive/behavioural/mindfulness therapies would definitely be worth a shot, John.
Are there any books or online courses that you might recommend?
panic_down_under
22-08-21, 06:48
Are there any books or online courses that you might recommend?
The best book I've read is 'Living with Fear: Understanding and Coping with Anxiety' by Isaac M. Marks (https://en.wikipedia.org/wiki/Isaac_Marks). I was given a copy when I was first hospitalised for PD back in the late 1980s. His 'Fears, Phobias and Rituals: Panic, Anxiety, and Their Disorders' is a pretty comprehensive explanation of what drives these disorders.
I've heard good things about myCompass (https://www.blackdoginstitute.org.au/resources-support/digital-tools-apps/mycompass/) a free online course run by the Black Dog Institute. For a comprehensive list of anxiety/depression resources see: Guide to Digital Mental Health Resources (PDF (https://www.emhprac.org.au/wp-content/uploads/2019/12/eMHPrac-Resource-Guide-Aug2020.pdf)) and Online therapy (eTherapy) (https://www.healthdirect.gov.au/etherapy).
Thanks Ian
I found that book second hand on eBay for $12 so I will give it a read once it arrives.
Will look into online courses tonight. Just trying to take it easy this week until I speak to my psych on Thursday regarding meds.
Also have some uncertainty at the moment regarding returning to work after it was shut down due a covid outbreak two weeks ago.
My agitation is still present even on the lower dose of paroxetine which is not helping.
Day 3 at reduced dosage and wow agitation through the roof.
Thought I could get through the day without benzos but just took .25mg clonazepam this evening.
Think I will have to switch to another ssri just to deal with the withdraws if nothing else.
How long will this last considering I was only on the paroxetine 10mg for 10 weeks? How can I make it easier on my brain?
Thanks John
panic_down_under
23-08-21, 10:00
Day 3 at reduced dosage and wow agitation through the roof.
While agitation can be a withdrawal symptom I would have expected it to ease when you lowered the dose if the AD was the cause. I think it probably had more to do with anxiety.
Thought I could get through the day without benzos but just took .25mg clonazepam this evening.
Did it help?
Think I will have to switch to another ssri just to deal with the withdraws if nothing else.
How long will this last considering I was only on the paroxetine 10mg for 10 weeks? How can I make it easier on my brain?
Given the small dose not long. The danger is that your mind could make things seem much worse than they really are.
Clonazepam helped a little bit with the agitation. I never really liked benzos and use them as a last resort.
Yes I know I will overthink things and I am trying to keep that in check with mixed success.
I hope your appointment today was productive and that you feel that you were listened to..
Hi pulisa,
Talking things out with the doctor helped.
The lack of routine I have experienced lately really has not helped my mental health.
After the covid scare at work management has decided to split the place up into “bubbles” with minimal contact between the different bubbles. While this will keep work safer in terms of virus transmission it also unfortunately means less social interaction and more isolation. :-(
Everyone will just have to live with this situation until there are enough people vaccinated and then some normality can return.
Regarding medication she has switched me over to lexapro. I will start a new thread in the lexapro forum to track my progress.
I was on paroxetine for about 3 months. The first month was horrid. Eventually the insomnia side effect went away. Other side effects persisted. Headaches, teeth grinding, not feeling myself and lastly agitation which was the last straw.
It did help with anxiety and depression somewhat and might have done more if I was able to tolerate a higher dose but that was not to be.
I told her about the dizziness and difficulty peeing on 10mg of amitriptyline and she said that should occur when taking much higher doses so this reinforced her belief that I am a slow metabolizer of anti depressant medication.
I cannot thank everyone enough who contributed to this thread PDU, Catkins and yourself.
I will see you on the lexapro thread shortly.
Regards
John
panic_down_under
27-08-21, 04:41
I told her about the dizziness and difficulty peeing on 10mg of amitriptyline and she said that should occur when taking much higher doses so this reinforced her belief that I am a slow metabolizer of anti depressant medication.
Amitriptyline is a fairly potent muscarinic acetylcholine antagonist which produces the peeing difficulty, John. But unless your liver, and to a lesser extend kidneys, are completely shot I doubt you're such a slow metaboliser that you can't tolerate less than one seventh of the normal amitriptyline starting dose. There are readily available blood tests to determine TCA plasma levels which would settle the matter.
I honestly do not know how people can tolerate such high doses of some medications.
When I was younger I could drink most people under the table. I didnt know how they couldnt tolerate alcohol.
We are all different.
Yes we are..
I'm glad you're going to try lexapro. I'm on 5mg daily and don't want to up it regardless of what may be considered the therapeutic dose. Fortunately my history with these drugs is enough to convince the doctors not to try to persuade me!
Good luck and hope you feel more reassured now after speaking to your psychiatrist.
Yep I am happy to be trying something more mainstream. Whether or not it works time will tell. When I was at my worst I was willing to put any crap into my body and pray for the best. Those bottom of the barrel medications as my psychiatrist called them may have worked for some people but for me they were pure poison. Lithium and respirodone spring to mind. Yuck.
Hope all goes well with the lexapro, I've never had it but will be interested to see how you get on. Paroxetine was the second one I tried, so I feel quite lucky that I found something that helped me relatively quickly - even though it didn't feel quick at the time.
I would have quite happily toddled on at my old dose if circumstances hadn't became too much to cope with and I had to up the dose.
Thanks Catkins.
Have started new thread in relevant section to track my progress.
John
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