Posted by ojopaj on August 30, 2000, at 16:48:42
Hi! I was hoping someone could answer my questions
about recent increases in anxiety symptoms despite
being on fluoxetine for 10 years. In the interest of
being thorough I've provided a lot of detail below,
which you're certainly welcome to skip through. Thanks
in advance for any help.History:
A little over 10 years ago I was diagnosed by our local
medical school's psychiatry dept. as having panic
disorder (attacks as frequent as 4 times per week,
with symptoms of "derealization", depersonalization,
difficulty breathing, and abject free-floating fear).After trying several MAOIs and tricyclics, I was
finally put on fluoxetine 20mg daily, which had a
profoudly positive effect. While the panic attacks
disappeared, I also noticed that my depression was
gone. (Corny and subjective as it sounds, I realized
then that I had been depressed my whole life and
hadn't known it.) Further, I found that a constant,
low-level anger and irritation (for lack of a more
psychiatrically accurate term) disappeared.I tried several times during the first 1-4 years to
taper off of the fluoxetine; each time, within 1 to 3
months, a panic attack would reappear. The low-level
anger/irritation usually returned within two weeks at
most.After several years, and several debilitating attacks
when off of the medication, I resigned myself to taking
fluoxetine the rest of my life if necessary ... I'll
do *anything* not to feel that panic again, frankly.Recent Concerns:
I have recently (within the last 6 months or so) found
an increase in anxiety symptoms, including one full-
blown panic attack (with depersonalization,
derealization, etc.) while *on* the fluoxetine. I later
attributed this to very high caffeine intake that day,
having read recently that caffeine seems to be able to
reverse some effects of SSRIs. Nonetheless it was
highly disturbing. As well, I've had an increase in
feelings of being "drugged" (i.e. "woozy", exhausted,
confused, much like one might feel when taking a
decongestant) lately, as well as a fairly constant,
low-level subjective perception of "mental slowness"
which seems most obviously characterized by difficulty
finding words. I have also found myself reversing
words and letters when writing, though I have never had
*any* difficulty whatsoever in that area before and
haven't been dyslexic or anything like that.My Question:
I'm wondering if any of the above concerns might "raise
flags" for any of the more educated among you as to
possibly being related to long-term SSRI usage. I'm
wondering if the fluoxetine has either 1) caused these
symptoms by long-term use, or 2) become less effective
over time, thereby causing these symptoms.Intevening & Confounding Variables:
There are several external environmental as well as
subjective psychological factors which may be
influencing these symptoms.Externally speaking, I have undergone a career change
recently, due to dramatic job stress (death threats
etc.; I did psychological counseling with criminally
insane). I've also cut back to only 40 hours of work
per week for the first time in 6 years, which has
precipitated some loneliness and social isolation as
I now have a great deal of free time and no idea how
to use it.I have also had some moderate medical problems lately,
primarily a bleeding ulcer, which I attribute purely
to stress. Nonetheless it has necessitated a complete
dietary change (including complete cessation of
caffeine and alcohol use) which, while being of great
benefit to me in the long term, might have an effect
on the "ol' neurochemical soup" -- I simply don't know.In terms of subjective psychological factors, the
above-mentioned loneliness has been prominent. As well,
a subjective sense of "who am I" and "what am I doing
here" has grown since I've left the psychological field
and have realized how much of my self-identification
and "meaning-making" were tied directly to my career.Given the above factors, it is entirely possible that
they may entirely account for my recent upsurge in
anxiety symptoms. If so, I will be greatly relieved,
as I generally prefer not to think about health and
medication concerns.Nonetheless, I'm left with several questions which I'm
hoping someone will brave my long-winded diatribe in
order to answer:1) Could any of these recent symptoms be related to
long term fluoxetine usage?2) Might changing my medication to another SSRI help?
Any other input or advice would be appreciated. I'm
also humbly open to the suggestion that I'm being
overconcerned and overanalytical about this, and that
given a few more months this should all simply
disappear.Unfortunately my primary care physician tends to react
to patients who are 1) very concerned about their
health and 2) concerned and/or resourceful enough to do
research on their own (such as I am doing now) as if
they're hypochondriacs or malingerers. As such I'm not
looking for that kind of reaction here unless it's a
genuine professional assessment of what you've read
here.Thank you very much for any help.
Ojo
poster:ojopaj
thread:44094
URL: http://www.dr-bob.org/babble/20000822/msgs/44094.html