Originally Posted by
KayMK
I just want some reassurance I suppose that its not making matters worse.
Unfortunately, serotonergic ADs can make anxiety worse at the beginning because of the increased serotonin activity. Despite the common myth, serotonin is not a 'feel good' neurotransmitter, just the opposite as you've discovered. But after some weeks the body and brain respond to the extra activity by down-regulating serotonin synthesis and expression and the anxiety and other initial side-effects begin to diminish. Fluoxetine has a very long half-life which can cause these initial side-effects to linger longer than they typically do for other SSRIs.
I have taken it before but stopped last October. Around 5 weeks ago I had an anxiety attack and was so panicked that I would be as ill as before I started myself back on 40mg straight away.
Which was unwise on several counts. Firstly, the usual starting dose for anxiety is 10mg due to the increased serotonin activity mentioned above. Secondly, for reasons that are not yet understood side-effects can become progressively more severe and/or different each time a AD is stopped and restarted. A higher dose may also be required to achieve previous levels of control.
The other issue is that ADs don't have a direct affect on anxiety (or depression) in the way, say, aspirin has on a headache. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature. Starting at a high dose won't significantly speed up this process, just increase side-effects severity.
I then had a terrible crash of symptoms around day 6 and ended up seeing the emergency dr who prescribed diazapam.
While diazepam is usually effective there are two potential problems with taking benzodiazepines (BZDs) for extended periods. As you probably know dependence can be an issue if they are taken for more than a month, or two, however, the bigger problem is that they can inhibit the growth of new hippocampal brain cells which can reduce, possibly cancel out the AD therapeutic response if taken regularly for extended periods. Small doses of the prescription antihistamine hydroxyzine (*Vistaril) is an alternative, but one not often prescribed in the UK for some reason. While not quite as potent as the BZDs it is often potent enough. It can be alternated with diazepam to reduce the risk of dependence and to limit interference in AD induced neurogenesis. If your GP won't prescribe hydroxyzine then ask for a small dose of mirtazapine instead.
*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.
I feel so foolish for just starting the tablets again. Im having strange symptoms, feeling edgy, shaky and if i try to nap during the day I get woken by a vibrating shaking sensation all through my body. My anxiety at points is horrific. Im not managing to work or do much at all.
Is there any light at the end of the tunnel. Feeling like Im not sure how much longer I can cope.
X
First step, discuss your situation with your doctor asap. If diazepam and/or hydroxyzine prove inadequate at easing the side-effects then consider reducing the fluoxetine dose to 20mg for a month or so, but okay this with your GP first.