Posted by BusuB on April 28, 2015, at 12:58:09
Good morning all. Some history, in 2009 I was diagnosed with Panic Disorder and Depression when a smoking cessation attempt went awry. When I quit smoking, my major complaint was that I was unbelievably restless and had terrible insomnia. As I wasn't sleeping well and it was hard getting through the day, I asked my GP for something to take the edge off and was promptly prescribed 0.5mg Xanax to take as needed. That night it knocked me out cold until 4 hours later when it started to wear off and I awoke in a full blown panic attack. My first of many of the next few months. After my 3rd ER visit I was referred to a psychiatrist who first trialed Buspar. When that didn't work, I was given Paxil a month later. Within a week I had decompensated so much (feelings of hopelessness, thoughts of death) that I begged to go into the hospital where I stayed for 5 days while they ramped up the Paxil while on Klonopin.
Whether due to the Paxil or in spite of it, I achieved remission in a clinical sense about 6 months later, although I still dealt with ongoing restlessness. I stayed on Paxil for 18 months before slowly weaning off. Weaning was rocky but it was done over 6 months from 50mg/day to 0.
Within 1 month of weaning, the panic returned and rather than riding it out to see if it would go away on its own I hopped right back on Paxil, only this time, it didn't seem to work as well and for 6 months I would deal with partial remission followed by relapse followed by increasing the dose.
After reaching 50mg Paxil with minimal improvement, it was decided to try Zoloft. Zoloft was tough starting out with like Paxil, with increased anxiety and insomnia. Made my way to 100mg and achieved about 6 months of stability but never fully controlled before again a minor relapse. An increase in dose to 150 gave me another 6 months before it started to turn on me. What I experienced at that point was what I would most closely describe as an akathisia like feeling where I couldn't get comfortable.
Ultimately, I was switched to Lexapro. Lexapro wasn't as activating as the Zoloft but I was still regularly restless on it as I was on Zoloft. Over the next 6 months, I was never happy with the results. I was either too stimulated to be comfortable, in a low mood or having insomnia that would get me up at 4:30 every morning. At the time, I figured it was unresolved symptoms related to my anxiety/depression and attempted to augment with lamictal (made my skin crawl until I broke out in hives) and amitriptyline. Ultimately I got off it because despite my continued problems with restlessness, insomnia and low mood, it ultimately made me not care about anything. Up to 20mg.
Up next Effexor. Couldn't tolerate. Made me restless as hell and hung on for 8 weeks. Up to 112.5mg.
Clomipramine, not as restless, seemed to do something for my anxiety at the expense of my colon health and my ability to remain up any longer than 3 hours at a time. Up to 75mg, 12 weeks.
Prozac, initially started to help with the clomipramine fatigue, but switched to mono-therapy when it didn't help. Welcome back restlessness and insomnia. Up to 10 mg, 12 weeks.
Cymbalta, 12 weeks. Nausea and fatigue with the restlessness and insomnia. Fun times! 60mg. Attempted to augment with Wellbutrin SR and couldn't handle the activation.
Brintellix, same reactions along with chest pain and anger 8 weeks, 15mg.
At this point, my pdoc felt I should take a break, believing that I was suffering more from iatrogenic effects of the medication more so than actual anxiety/depression. From there I tapered down to 5 mg brintellix and was thrown into what I first thought was withdrawal. I had the normal stuff. Zaps, nausea, flu-like feelings, nausea... but what accompanied it was also low moods, anxiety and unrelenting restlessness.
After 2 weeks of this I became concerned. Everything out there says 1-2 weeks for these issues to resolve, but I held firm. Maybe I just needed a little more time. Weeks 3-4 were much the same. Weeks 5-6, the restlessness became more prominent culminating in a panic attack. My first one in years.
After finding out my pdoc was out of town with no back up in place to see me in an emergency I got in to see my primary care who promptly prescribed Celexa and propranolol to start until I could get in with the pdoc.
Celexa presented the same issues as Lexapro, except more fatigue. Augmented with Trileptal gave me paradoxical insomnia. I hung onto that for 5 months before throwing in the towel due to the anhedonia. Up to 20mg.
Remeron followed. 8 weeks. Up to 45mg. I was not anxious. However: Couldn't stop eating. Couldn't stay awake. Started getting angry and taking it out on my wife and child. Wife begged me off.
Lyrica was the last drug I've trialed. I was only on it for 3 weeks as 75mg bid before it started killing my mood. After 3 straight days of weepiness I asked to discontinue. Due to being at such a low dose for such a short amount of time, I was allowed to d/c cold turkey. Within 2 days, I was hit by nausea, anxiety, restlessness (like the most uncomfortable caffeine buzz you've ever had), headache, and insomnia. I thought to myself, must be withdrawal.
That was 10 days ago, and I'm still feeling all of the above, and to be frank, I really don't know if it's my anxiety, or withdrawal. I'm also getting disheartened that it appears that I'm running out of options. My pdoc suggested that we should start looking at AAP's for symptom relief but I've never given any indication of bipolarity/schizophrenia, and I'm not on a AD for the AAP to augment in treatment of MDD. I just don't get it.
If it is withdrawal, how long should I wait this out? If it isn't, and meds are once again in my future should I expect anything from the AAP's in calming my primary symptoms of restlessness/anxiety? Could this all have been one massive 5 years iatrogenic cluster f*ck? I keep thinking to myself that if I had just waited out the nicotine withdrawals I would've avoided all of this.
In short:
SSRI's: (all except Luvox/Viibryd) Make me restless and give me insomnia. Celexa/Lexapro twins give the added bonus of anhedonia. Brintellix made me angry.SNRI's: (Effexor/Cymbalta) Same as SSRI's with added nausea.
TCA (only clomipramine): terrible fatigue, constipation.
TeCA: (remeron)Fatigue, hunger, angry.
AE/AC's: Tend to not mix well either lowers mood, increases anxiety or increases insomnia.
BZD's: Work okay as long as I'm on them although they make me groggy. The come downs give me rebound anxiety for the shorter acting BZD's and rebound depression on the longer acting ones.
Pdoc discussed next steps as Latuda, Abilify or Saphris mono-therapy. He wants to avoid the metabolic side effect and grogginess of Seroquel, it seems. He seems to think that further trials of TCA's would also give unsatisfactory results/side effects although I have great interest in Pamelor/Norpramin. Pdoc said hell no to Nefazodone. I've taken Trazodone for insomnia on/off through the last 5 years.
Any input would be appreciated.
poster:BusuB
thread:1078520
URL: http://www.dr-bob.org/babble/20150407/msgs/1078520.html