Appointment with the psychiatrist - how it went

[Junot]

It went well. We've spent about one hour and a half discussing my symptoms and treatment plan and he quickly managed to trap me in my own distorted mind patterns.

Good news: he referred me for CBT to correct those mind patterns and told me that if everything goes as planned I'll be fine in about 6 to 9 months.

Bad news: he prescribed me an antidepressant, Cymbalta (duloxetine), even though I objected.

He also prescribed me Xanax XR 1mg to take twice a day until the antidepressant effect sets in (a time frame of about four weeks).

I'm confident in his expertise but I'm still very reluctant regarding the antidepressant because it is a serotonin-noradrenaline reuptake inhibitor. I expressed my concerns to the doctor but he told me not to worry about it.

I hope this works!

[chickpea]

Well done for seeing it through, Junot!

What is it about the SNRI medication you're worried about?
I have been on Seroxat and Citalopram previously.
When I started the Citalopram, I will be honest it did make me feel worse for a few weeks. However, that was because I was started on quite a high dose (20mg) and had an extreme initial reaction to it. If I was ever to take it again, I would start on the lowest dose possible and even cut tablets in half and build up the dose very gradually.
In contrast, I weaned myself of Citalopram after about a year with no real problems - just the odd brain zap.

I think you need to put your faith in your psychiatrist and follow his advice to the letter, not only because he knows what he's doing, but also because it is the first step in overcoming our HA. Trust him utterly and give yourself over to his care.

[Fishmanpa]

Well done! Sounds like he has a plan and nailed you in an hour ~lol~

Both my sister and daughter take an anti-depressant and they do just fine. Listen to this man... from what you said, he sounds like a winner and you'll do just fine. CBT is pretty cool actually and I used it to help with some minor depression and it really helps when the "scanxiety" ramps up. Like I said, you'll have to work on it and practice the techniques but there are many here who have successfully utilized it and gotten better.

Again.... Way to go Junot! This is the first step on the way to becoming a dragon slayer

Positive thoughts

[eeesh]

Well done! Sounds like he has a plan and nailed you in an hour ~lol~

Both my sister and daughter take an anti-depressant and they do just fine. Listen to this man... from what you said, he sounds like a winner and you'll do just fine. CBT is pretty cool actually and I used it to help with some minor depression and it really helps when the "scanxiety" ramps up. Like I said, you'll have to work on it and practice the techniques but there are many here who have successfully utilized it and gotten better.

Again.... Way to go Junot! This is the first one on the way to becoming a dragon slayer

Positive thoughts

What is that??

[Fishmanpa]

"Scanxiety": Anxiety directly related to post cancer checkups/scans. I go every three months for the first two years and then every 6 months to five years. In my case, I have a 50/50 chance of the cancer recurring with in the first two years and then it's goes to 80/20 in my favor out to five years. I'm at 18 months out with the end of April 2015 being the two year mark. So yeah, I get a little stressed every three months

I was given Buspar which I started the other day. My appointment is the 18th. The beauty of it is that it just takes the edge off and I can stop cold turkey without side effects. Between that and the CBT techniques I got a stranglehold on the dragon for sure

Positive thoughts

[Junot]

Hello,

chickpea, what worries me in SNRIs is noradrenaline. They're supposed to increase its concentration in synapses. I hope that the drug acts mainly on the central nervous system (brain). The last thing I'd want at the moment would be to feel the effects of a shot of noradrenaline in organs such as the heart.

Fishmanpa, I will start with weekly sessions of CBT. Depending on my progression, I will eventually switch to biweekly sessions and so forth. I'm really confident in a good outcome. I'm willing to work hard on it and to finally overcome the nightmare that has got me trapped all of these years.

I will put my faith on the psychiatrist and comply with his directions regardless of my concerns regarding the antidepressant. He told me to call him whenever I need. For example, if I happen to have any doubts on the medication or I experience eventual side-effect symptoms that unsettle me. So, he put me at ease, and that's definitely a good start.

[MyNameIsTerry]

Hello,

chickpea, what worries me in SNRIs is noradrenaline. They're supposed to increase its concentration in synapses. I hope that the drug acts mainly on the central nervous system (brain). The last thing I'd want at the moment would be to feel the effects of a shot of noradrenaline in organs such as the heart.

I'm on Duloxetine, have been for a few years now.

You start on a 30mg half dose for GAD and then increase it to 60mg after a week or so. This means that the side effect window comes in 2 phases and the symptoms may differ between them.

I found adjusting to the 30mg wasn't too bad. The adjustment to 60mg was a harder task because it brought increased anxiety and adrenaline rushes. Now, you may not experience this as these medications all affect us differently but if you do, try to remember that it is a side effect and it won't last. My 30-60mg adjustment lasted 8-10 days and I knew it was just side effects so I just persevered and told myself it could change the next day.

If you feel these side effects are too much, and I'm not suggesting you don't try them, the impact on adrenaline seems reduced in Venlaxafine as discussed on the board about it but it starts to interact again at 150mg so it would depend whether you were going onto that dose anyway.

They were worse in the mornings upon waking and I stuck it out for as long as possible but on the last day took 1 Diazapam. So, tough it out but if you notice a pattern like this the Xanax might help you through it.

Again, I don't want you to feel put off by this, anti depressants can all cause side effects and I know how much you can dread this before you start as I was the same, but I believe in being clear and I hope that if you do experience any symptoms from increased adrenaline that you will recognise it as nothing more than a side effect that will pass as opposed to you rushing on here for advice on why you feel a certain way which is going to be harder for someone with HA than GAD like me.

[Junot]

Hi MyNameIsTerry,

Yes, I'm starting on a 30mg/day dose for two weeks. Then I will start taking 60mg/day. I've just taken the first capsule! So far so good, but I'm still apprehensive in regards to the eventual side-effects. Thanks for sharing your experience.

As to Xanax, he told me to call him if I feel like 1mg twice a day isn't enough to calm me down. He said that the dose can be increased up to 6mg/day if necessary, so this is kind of a safety net I have in case I happen to experience unsettling side-effects due to the antidepressant adjustment. I also have another benzodiazepine to take, but only in an emergency, to help abort a panic attack. It's generic name is ethyl loflazepate.

I forgot to say on the original post what the diagnosis was. According to the doctor I have GAD, panic disorder with agoraphobia, hypochondria (health anxiety) and a mild depression caused by the former conditions.

---------- Post added at 15:59 ---------- Previous post was at 12:15 ----------

By the way MyNameIsTerry, did you experience nausea with the 30mg dose?
I've been feeling so nauseated since I had lunch. I took the 30mg capsule with breakfast. Hope this goes away fast.

[MyNameIsTerry]

Hi Junot,

I didn't really go into side effects much as I don't want to put people off, this being a HA board afterall but if you want to know anything about my experience, I will happily share it.

The first time I took the 30mg dose I was sitting in front of the toilet about 20 minutes later from the nausea. This passed after about an hour though. It happened again the next time I took the dose but it wasn't as strong. After these first 2 doses it was gone.

I didn't get any nausea after this, even when increasing to 60mg. The side effects changed when upping the dose.

I also found that I had better periods after a short time on 30mg but then this wained and the anxiety started coming back. Since 30mg is only a starting dose, I just saw this as a temporary improvement that was never going to last.

I think the fact you have support is crucial here. I have been on two anti depressants over the last 8 years and starting each made my anxiety worse and I spent months crawling back to where I was before even asking my GP for help. By having someone there throughout, I think you will handle this better.

I think its a good sign you are ok on 30mg. There was a member on one of the other boards who suffered terribly from day one on this medication so I was concerned how a move to 60mg might affect him. In your case you seem to be responding in the normal way so I think its likely you will adjust better on the 60mg.

Just remember if the adrenaline does come at the 60mg, try to use your other meds to balance it out, talk to your support and come on here. I found this stage very difficult and I didn't know what I was experiencing at the time so it was more scary than it should have been, but you have the support to tell you that its just side effects if it does happen and can use any techniques your support gives you to get you through.

Something I also found was that, whilst more intense, I adjusted to this one far quicker than Citalopram which was more like 4 weeks. So, keep that in mind, whatever happens, it should pass quicker.

[Junot]

Hi,

Thanks again for sharing more of your own experience.

Interestingly it seems that both of us have experienced a similar pattern of nausea. Yesterday, day 1 of Cymbalta 30 mg, I spent most of the afternoon feeling nauseated (and a bit lightheaded as well). Yet, today I didn't feel anything unusual.

I'm actually feeling less anxious and a bit more positive in regards to life. I don't know yet whether it's due to Cymbalta or to Xanax 1mg twice a day. But I definitely feel that something's working on my brain's chemistry. The long appointment with the psychiatrist and the prospect of starting CBT soon might have contributed to ease my chaotic state of mind as well.

Thankfully I haven't experienced yet any heart-related symptom (e.g., palpitations - said to be common with this drug). Let's wait and see how the adjustment to the 60mg dose goes.