Panic attacks 'peeking' through my Lexapro - Apple Watch...

[panicface]

Have been on Lexapro for about 4yr now. Life changing (for me). Took the everyday anxiety away, some of the paranoia (maybe just fear of 'fear') and enabled me to travel again.

About 18 months ago I decided to party hard for a month or so and had a series of crazy panic attacks. The 'outcome' was that drinking heavily lowers the effectiveness of Lexapro, so each day I was taking my 10mg, but it wasn't working as well.

First Dr. pushed me up to 15mg daily, and then I cut down on the drinking. Back in Lala land with rainbows, unicorns, and bliss.

The last 4 months or so I've realized my Apple Watch does a phenomenal job of warning me about a panic attack. My usual sleeping HR is in upper 50's or low 60's. Typical resting HR (on computer in bed) is under 75.

But for no good reason, sometimes (without any outside stressors) my HR will start to creep up over a half a day... Baseline moves to 80, 85, 90's and by the time it hits 100 - I've already reached for 1/2 of Xanax.. 30 min later - all is good again (Except I'm now sleepy).

Question - the past month or two it's gotten more often. Whereas before this 'creeping up' happened once a month or so, now it's two times a week. Usually (but not always) at night while laying in bed watching a movie or chilling.

I don't think it's physical (I do an hour of cardio daily with no HR issues)... I'm afraid instead it's the Lexapro dosage.

I don't want to move to 20mg as (1. it's expensive in my country - $2 a 10mg pill), 2. It murders my sex drive (what sex drive).. 3. I'm scared I'll top out... Where Lexapro will no longer work for me....

Anyone experience this? Any ideas?

Once I did try to transfer over to Buspar, I bought some online, but then chickened out due to fear of anxiety period when switching.... Is there another drug I could switch to, or a way I could go back down to 10mg and start over?

Appreciate it.

[panic_down_under]

The 'outcome' was that drinking heavily lowers the effectiveness of Lexapro, so each day I was taking my 10mg, but it wasn't working as well.

Alcohol does more than reduced the effectiveness of Lexapro (escitalopram). Anxiety and depression are the emotional manifestations of an underlying physical brain dysfunction, atrophy of the two hippocampal regions of the brain caused by high brain stress hormone levels, particularly of cortisol, killing brain cells and inhibiting the growth of replacements. See also: Depression and the Birth and Death of Brain Cells (PDF). Both therapy and antidepressants work by stimulating the growth of new hippocampal brain cells. The cells produce the therapeutic effect, not the treatments directly.

The problem is alcohol has the same affect on hippocampal neurogenesis as cortisol. Even moderate drinking can result in significant hippocampal atrophy (Topiwala A, 2017; - see also: Anderson ML, 2012; Morris SA, 2010; Crews FT, 2003).

But for no good reason, sometimes (without any outside stressors) my HR will start to creep up over a half a day... Baseline moves to 80, 85, 90's and by the time it hits 100 - I've already reached for 1/2 of Xanax.. 30 min later - all is good again (Except I'm now sleepy).

Have you told your doctor about the elevated heart rate? If not you should. While it is likely caused by anxiety/stress there are other possible explanations which should be ruled out.

It takes about 30-45 minutes for Xanax (alprazolam) to being entering the bloodstream and 1-2 hours to reach peak plasma so I suspect the heart rate drop within 30 minutes has more to do with the placebo effect than the med.

I don't think it's physical (I do an hour of cardio daily with no HR issues)... I'm afraid instead it's the Lexapro dosage.

As per above, get it checked out as while it might be breakthrough anxiety there are other possible explanations.

I don't want to move to 20mg as (1. it's expensive in my country - $2 a 10mg pill),

Are 20mg pills twice the price too?

2. It murders my sex drive (what sex drive)..

There are ways of reducing SSRI induced sexual dysfunction.

3. I'm scared I'll top out... Where Lexapro will no longer work for me....

It may not be working for you at 15mg. Raising the dose won't increase the risk of pooping-out.

Once I did try to transfer over to Buspar, I bought some online, but then chickened out due to fear of anxiety period when switching.... Is there another drug I could switch to, or a way I could go back down to 10mg and start over?

The bad news is that Buspar (buspirone) is one of a number of meds which work well for some, but not at all for most and then only for GAD and sometimes social anxiety. It rarely if ever works for Panic Disorder, PTSD, or OCD.

The possibly better news is that when taken with serotonergic ADs such as escitalopram it may boost their effectiveness, has a good track record for reviving pooped-out ADs and may ease some of their side-effects, including sexual dysfunction. However, I urge you to discuss its suitability with your doctor before trying it as there may be valid reasons why you shouldn't take it with your AD.

[panicface]

Whoa, one response and it's a great one.. I feel like it's Christmas,,, okay - let me unpack this.

It takes about 30-45 minutes for Xanax (alprazolam) to being entering the bloodstream and 1-2 hours to reach peak plasma so I suspect the heart rate drop within 30 minutes has more to do with the placebo effect than the med.

Wow, this is new info for me. I've been taking Xanax off and on for 35 years and about the 20-30 mark it feels like someone stepped into my head and 'flipped off the anxiety switches' - I've seen it over and over, over decades.. During panic attacks, on planes, etc. 30 min is the 'load' time for me. I let it dissolve under my tongue (which I believe makes it available faster?) Dunno. Or maybe it's all in my head? Anyway - it does work for me.

A quick trip to Google-Town shows:
"Some people may first begin experiencing the effects of Xanax within 5 to 10 minutes of taking the pill. Almost everyone will feel the effects of the drug within an hour. One of the reasons why Xanax is so effective for treating panic is that peak impact from the dose comes quickly."

Are 20mg pills twice the price too?

For whatever reason, they're only selling 10mg pills here at the doctors and different pharmacies. Otherwise I'd just split them.

Interesting side story: I have a USA mailing address and managed to score 180 20mg Lexapro tablets via Galieo Health and Honeybee Pharmacy for $20. This was a Phenomenal savings. Compare:
- 360 (10mg) doses for $20
- 360 (10mg) doses here for almost $700... Yikes.

They only had two brands 'Solco' and 'Lupin'. I tried the Solco and was happy for about 3 or 4 days until I started having massive, random panic attacks. I continued on for another week (almost catatonic in bed in fear of another).. Until my GF mentioned they started when I switched pills.. DOH!.. I switched back to the local ones (Jovia) and within a couple of days - blue skies again... They 'should' have the same active ingredient.. However, for my body; I guess not all meds are created equally.

There are ways of reducing SSRI induced sexual dysfunction.

Wow!! PLEASE tell me how? I used to have an active sex life with my partner (every few days). Once on Lexapro sex went down to once every two weeks or month.. IF I took a Viagra, and mostly to please her. I get nothing at all out of it. Though it physically feels good, there's a disconnect between brain/body.. I would LOVE to hear how to reduce these awful side effects.

The bad news is that Buspar... The possibly better news is that when taken with serotonergic ADs such as escitalopram it may boost their effectiveness, has a good track record for reviving pooped-out ADs and may ease some of their side-effects, including sexual dysfunction.

The doctors here are a joke, sadly. I live in a poor country where education is not the best. I tried a few psychologists at the local hospital. When my anxiety was horrible from traveling.
- First wanted to spend our time talking about how I got the money to do all this travel
- Wanted to know what my western doctors had told me and seemed to want to just repeat whatever they had said
- Third wanted to talk to me about God, and how accepting God in my life would relieve my anxiety

So, now I just go to my local 'kitchen-sink' doctor who does everything from Botox / STDs / hand out pills for crazy folks like myself.

Are you saying I might research if taking a low dose of Buspar might be beneficial?

Thanks so much for any response.

[panic_down_under]

I let it dissolve under my tongue (which I believe makes it available faster?)

Ah, that explains it. Taking it sublingually - under the tongue - will significantly reduce the time for Xanax (alprazolam) - and many other meds - to begin working because it enters the bloodstream faster that it does via the stomach. In some countries Xanax is available in oral disintegrating tablets which dissolve in the mouth.

A quick trip to Google-Town shows:
"Some people may first begin experiencing the effects of Xanax within 5 to 10 minutes of taking the pill.

...One of the reasons why Xanax is so effective for treating panic is that peak impact from the dose comes quickly."

I doubt many would get such a quick response, plus panic attacks usually don't continue for long, typically 5 minutes, not often for more than 10 minutes, however, they leave people very anxious which Xanax will ease fairly quickly.

For whatever reason, they're only selling 10mg pills here at the doctors and different pharmacies. Otherwise I'd just split them.

That maybe why they are only selling escitalopram in 10mg tablets. Patients splitting 20mg tablets would halve their income. Here 28 x 20mg tablets cost $0.02 more than 28 x 10mg tablets.

360 (10mg) doses here for almost $700... Yikes.

I don't know why people still rob banks. Ripping people off selling meds is nearly as profitable and there's very little risk of going to jail.

They only had two brands 'Solco' and 'Lupin'.

Solco is owned by a Chinese pharmaceutical company and while it may be making the tablets in the U.S. my guess is the drug itself comes from China.

Wow!! PLEASE tell me how?

I linked to the post. It's at: http://www.nomorepanic.co.uk/showpos...31&postcount=7

Are you saying I might research if taking a low dose of Buspar might be beneficial?

Taking a small dose - 10-30mg - of Buspar (buspirone) with Lexapro may reduce some Lexapro side-effects and increase its effectiveness. But you should seek medical advice before taking it as it may not be suitable for you especially if you have other medical conditions. This also applies to the other medications and remedies such as Ginkgo I listed in the sexual dysfunction post.