Up and Down...why?

[panic_down_under]

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>

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 and maybe reverse plaque buildup (see also: Nelson RL, 2007).

[Utah49er]

OMG, you're an evil used car salesman <backs away while frantically searching for a crucifix and garland of garlic>

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 and maybe reverse plaque buildup (see also: Nelson RL, 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!

[PixieP]

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]

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! 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.

[hanshan]

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.

[Utah49er]

Been there, done that, got the tee shirt! 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]

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.

[Utah49er]

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]

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.

[hanshan]

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.