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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Sabina on June 10, 2003, at 15:36:15
I have long suffered from chronic illness (Fibromyalgia/Chronic Fatigue), which has only exacerbated my hereditary tendency toward anxiety and occasional low tolerence for emotional stress. At various times in the past I have been given: Prozac, which seemed to do nothing for me; Paxil, which tweaked me beyond ALL belief; Zoloft, which made me an absolute zombie; and, most recently Lexapro, which I have been on for just 7 days. In that time I have experienced sweating, leg pain, nausea, headaches, depersonalization, anorgasmia, anxiety, suicical ideation, extreme depression, urinary hesitancy, somnolence, and so on. My doctor, an Internist, told me that I WASN'T experiencing any of these due to the medication, and that I was to take the 10mg she perscribed (I had tried to go down to 5mg) or come see her to "talk about it." I swear I can feel the effects of this drug, and it is highly invalidating to hear otherwise from a "professional." Prior to taking it I was only experiencing occasional anxiety, with nausea and headache not unfamiliar due to the FM/CFS. I have been avoiding taking SSRI's (dr's first, nearly only, choice for FM) due to bad past experiences. This one's turning out to be the worst yet. I am in therapy for help with coping with a chronic illness, but not with an MD. I feel I should be on Buspar for anxiety, but the infallible attitude of this Internist is scaring me. Can anyone else say they've felt effects so quickly? I think I'm just very sensitive to SSRI's. Sorry to ramble. Thanks for your time. I've been reading for a week.
Posted by Bill L on June 10, 2003, at 16:20:04
In reply to SSRI woes, please help , posted by Sabina on June 10, 2003, at 15:36:15
Hi Sabina. It sounds like you are really having a rough time. Do you suffer from depression? I know that that is one of your Lexapro side effects.
Buspar helps some people. Have you ever tried a prescription antianxiety drug? Have you tried Effexor? Effexor is often used successfully for anxiety and/or depression.
Your Lexapro side effects are not uncommon. Except maybe for the depression side effect. But they generally go away with time, like after a month or so. With many people, tiredness and anorgasmia will not completely go away.
I guess that I would recommend giving the Lexapro a few weeks before giving up on it. Then ask your doc to give you Effexor if you haven't already tried it. I think that you could also take Buspar along with Effexor. And also consider an anti-anxiety drug either alone or with an antidepressent.
If your doc gives you a hard time, try a different one. The important think is that you see a competent doc that you feel comfortable with. That's more important than whether your doc is an internist or a psychiatrist.
Posted by Sabina on June 10, 2003, at 16:39:45
In reply to Re: SSRI woes, please help , posted by Bill L on June 10, 2003, at 16:20:04
Thanks for the reply, Bill. I do have occasional depression, but no more than most people who are dealing with chronic health issues. My problem is more just feeling more tweaked than a given situation calls for, i.e. driving in the rain, irrational fear and worry. I told my doctor that I WASN'T depressed, just nervous, but she had free sample of the new and improved Celexa (Lexapro) and I finally gave in and said okay. I do want to give it a fair chance, but I hate to be such a basket case in the mean time. I've already seen SO MANY doctors, though, so hopefully this one will be receptive to the Effexor/Buspar suggestion at my one month check-up (if I can make it until then). It just really bothers me when I called her office with concerns about my side effects and was told that it wasn't true. Still, I wasn't depressed, or sweating (how could I imagine making that one up?!), or any of the other stuff until I'd taken the Lexapro for a few days. This is just a really hard time for me, and I appreciate your quick reply and suggestion. It definitely makes things easier to bear with a positive peer network and I've never had that before.
Posted by Chris O on June 10, 2003, at 17:47:15
In reply to Re: SSRI woes, please help , posted by Sabina on June 10, 2003, at 16:39:45
Sabina:
Your doctor sounds typical of many I've seen: unempathic when it comes to people suffering from anxiety and/or depression. That is simply wrong that the doctor would tell you that what you are experiencing "is not true." Such invalidation is barbaric at best, but then, that's what you get with this outdated patriarchal system of medicine we are still struggling with.
I have not taken Lexpro, but I had similarly rapidly occuring side-effects on Effexor (apologies to Bill on this one). Within a couple of days of starting Effexor, I had severe headaches, constipation, sweating, nausea, numb hands and feet, and of course, the annoying anorgasmia that comes with all these lovely meds.
If you feel bad on Lexapro, I say, give it a go for a few weeks (or days) then go back and ask for a different med. Hey, it's your health insurance, not the doctor's.
Posted by Beastress on June 10, 2003, at 18:57:43
In reply to SSRI woes, please help , posted by Sabina on June 10, 2003, at 15:36:15
Hi Sabina,
I'm sorry to hear about the SSRI problems, as if CFS/FM wasn't enough to deal with. I have not been diagnosed with FM, but my doctor suspects it. FWIW, She wants me to consider using a tricyclic antidepressant to deal with some of the symptoms. She seems to feel that SSRIs aren't very helpful for FM in many cases. I know very little about TCAs and haven't come to a decision about using one, but maybe a non-SSRI might be more effective for you?
Posted by Beastress on June 10, 2003, at 19:11:44
In reply to SSRI woes, please help , posted by Sabina on June 10, 2003, at 15:36:15
Sabina,
Here is a link to a post that I found helpful, hope it helps you too.
Posted by Bill L on June 11, 2003, at 8:52:47
In reply to Re: SSRI woes, please help , posted by Sabina on June 10, 2003, at 16:39:45
Have you tried xanax or any other anti-anxiety drug?
Posted by Sabina on June 11, 2003, at 16:09:24
In reply to Re: SSRI woes, please help , posted by Bill L on June 11, 2003, at 8:52:47
Beastress, I have tried TCA's in the past with no discernable benefits. However, I think the dosage may have been too low.
Bill, As per your kind suggestion, I called to inquire about adding Xanax, and my doctor has agreed. Hopefully, that will help get me over the rough spots until I see her again in three weeks, at which time I plan to ask about Buspar. Xanax just makes me a little stoned, but I work at home, so that should be okay.
I also felt somewhat relieved when my therapist saw how tweaked I was this afternoon and told me that if I got anymore flak about the doc denying my Lex side effects that she would call her personally and back me up. She said some people are just very sensitive to SSRI's and not to let her invalidation get me down too much. Thanks to her support and that of everyone here, I'm going to try to push on through. Thanks again, Bina
Posted by JLM on June 12, 2003, at 2:22:50
In reply to Re: SSRI woes, thanks for helping, posted by Sabina on June 11, 2003, at 16:09:24
> Beastress, I have tried TCA's in the past with no discernable benefits. However, I think the dosage may have been too low.
>
> Bill, As per your kind suggestion, I called to inquire about adding Xanax, and my doctor has agreed. Hopefully, that will help get me over the rough spots until I see her again in three weeks, at which time I plan to ask about Buspar. Xanax just makes me a little stoned, but I work at home, so that should be okay.
>
> I also felt somewhat relieved when my therapist saw how tweaked I was this afternoon and told me that if I got anymore flak about the doc denying my Lex side effects that she would call her personally and back me up. She said some people are just very sensitive to SSRI's and not to let her invalidation get me down too much. Thanks to her support and that of everyone here, I'm going to try to push on through. Thanks again, BinaBina,
1. fire your Internist :)
2.http://www.immunesupport.com/library/bulletinarticle.cfm?ID=3618
Dr. Cheney has probably forgotten more about CFS than most people have ever known. Do a search on Google for "Paul Cheney"
"Paul Cheney, M.D., on SSRIs and Stimulants for Chronic Fatigue Syndrome: Frying the Brain? ImmuneSupport.com
06-05-2002
By Carol Sieverling
Editor?s Note: This information is based on tapes of Carol Sieverling?s October 2000 patient visit with Dr. Cheney. He gave permission to share this information, but has not reviewed or edited it.
Dr. Cheney recently came across some information regarding the dangers of Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac, Zoloft and Paxil, and stimulants like Ritalin and Provigil. During office visits, Dr. Cheney shows patients the book Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil and Other Antidepressants by Joseph Glenmullen, M.D., a psychiatrist at Harvard Medical School. It includes endorsements from other Ivy League psychiatrists. Cheney calls the implications of this book "staggering."
When talking with patients, Cheney usually opens the book to a picture of a monkey's brain before and after it received a very potent SSRI. The "before" photo shows a dark background filled with fine white lines and white blobs, healthy neurons. The "after" photo is very dark, only a few white lines and blobs remain. Most of the brain cells had been "fried."
SSRIs and stimulants work by increasing the firing of neurons. While this often has great benefits in the short term, doctors are now realizing that long term use "fries" brain cells. The body views any neuron that fires excessively over time as damaged, and destroys it.
SSRIs and stimulants, taken over a period of 10 years or so, can lead to a loss of brain cells, causing neurodegenerative disorders. Many doctors have recently seen a sudden increase in patients with neurological symptoms, and most have been on Prozac, or a similar drug, for about 10 years. Cheney is seeing this in his own practice.
During office visits, Cheney also shows patients a copy of the May 22, 2000 issue of Newsweek with Michael J. Fox on the cover. It has an excellent article on Parkinson's Disease, a condition that involves a loss of neurons in the area associated with motor control. Parkinson's drugs stimulate the remaining neurons to "perform heroically," firing excessively. However, the article notes that while benefits are seen initially, neurological symptoms get much worse at the three to five-year point. Patients experience wild involuntary movements, etc. These drugs, though helpful in the short term, actually speed up the degenerative process.
What mechanisms are at work causing neurons to be "fried?" SSRIs are often prescribed for depression, which involves a lack of serotonin. Serotonin is a neurotransmitter, a chemical messenger. One neuron releases a burst of it into the intersynaptic cleft, (the gap between neurons). The serotonin is then taken up by special receptors in the adjacent neuron. Thus a message is sent from one neuron to another, with serotonin carrying the message across the gap. Excess serotonin is cleared away before a new message is sent. A "reuptake channel" in one neuron vacuums up the left over serotonin.
SSRIs are designed to address a lack of serotonin by blocking the reuptake channel from vacuuming up excess serotonin. While this allows more serotonin to connect with the receptors, often too much is left floating in the intersynaptic cleft. The only way the body can get rid of this excess serotonin is to oxidize it. Unfortunately, this turns it into a toxic compound that, over time, kills both the sending and receiving neurons.
Cheney stated, "What starts out as an attempt to increase serotonin and reduce symptoms ends up with the destruction of the serotonergic system itself. It takes about a decade, more in some, less in others.
Now when the serotonergic nerves are dead, you start getting these motor neuron problems, which is what we're seeing." Cheney commented, "You know what a lot of doctors (who do not understand CFIDS) are doing? They're saying 'Well, let's just give them an antidepressant'. And they are frying their (patients') brains and they don't even know it. In fact, a CFIDS patient on one of these drugs fries their brain even faster than a non-CFIDS person." (See the article on Klonopin for an explanation.)
Cheney went on to say, "The other way some people with CFIDS are going is stimulating the brain, using drugs like Ritalin or Provigil. They do the same thing - they fry the brain. They cause neurons to fire at lower stimulus by lowering the firing threshold. All stimulants are dangerous, especially over the long haul. I'm not saying that you might not find them useful in the short-term. But over the long term, the physiology demands that neurons that fire excessively be killed."
Cheney strongly urges anyone taking antidepressants or stimulants to read Glenmullen's book, which lists safe alternatives to SSRIs."
You are not alone. I have a similar fatiguing illness know as Postural Orthostatic Tachycardia Syndrome, and SSRI's just flat layed me out. Zoloft gave me akathisia to the point where I felt suicidal. Didn't sleep for about 4 days either, since I felt like constantly pacing the floor. Needless to say, I stopped the Zoloft, and all the nasties stopped as well.
Hope this helps!
BTW, I have Glenmullen's book. I have seen the referenced photo. It isn't pretty. I believe the drug they are referencing thou is Redux, which is a serotonergic drug. My friend has the book thou, or I'd look it up.
Posted by McPac on June 12, 2003, at 12:35:23
In reply to Re: SSRI woes, please help , posted by Sabina on June 10, 2003, at 16:39:45
I would bring the Lexapro to this pathetic doctor, tell her to take them, and leave them both behind!
Posted by Sabina on June 12, 2003, at 14:37:32
In reply to Re: SSRI woes, thanks for helping » Sabina, posted by JLM on June 12, 2003, at 2:22:50
Wow! Thanks for the link/info. I will definitely explore this avenue of information further and go armed and ready for my next visit in three weeks. Her response at that point will be critical, obviously. Sad to say, she is the best one I've seen so far, so I want to give her the benefit of another chance. I'm still quite peeved and I did actually already entertain the fantasy of telling her to take Lex for a few days and then tell me she felt nothing. The Xanax does seem to be helping to keep me from the picking at my fingers kind of nervousness, but it's difficult to function properly while stoned/sleepy all the time. I really appreciate your suggestions and encouragement. I realized a long time ago that my health, both emotional and otherwise, was in my own hands. The trick is to find a physician that respects your input...there must be one somewhere. ;)
Posted by Viridis on June 13, 2003, at 0:53:10
In reply to Re: SSRI woes, thanks for helping JLM McPac, posted by Sabina on June 12, 2003, at 14:37:32
I had a terrible time with SSRIs. I told my current pdoc this, and he initially decided to try Zoloft, which he considers a "gentle" SSRI, at a very low dose (he said it had worked pretty well for him, although he had side effects -- it's nice to have a doctor who's actually taken these meds).
After seeing my reaction, he told me that I was just one of those people who can't tolerate SSRIs. He didn't seem to read much into it; he considers them good drugs for many, but says that some people just don't react well, and advised me to avoid SSRIs in future.
I do much better with Klonopin, Neurontin, and Adderall, plus a bit of Xanax now and then. My pdoc and I worked together to come up with this combo, and I'm quite pleased with it. My diagnosis is ADD, panic disorder, and major depression.
Klonopin (clonazepam) really can be helpful for anxiety, although it may take a short time to get past the initial sedation etc. (that disappeared quickly for me). One other med you might consider is Provigil (modafinil); I took it for a short time. Although it didn't help much with ADD issues (which is why I'm taking Adderall), it was energizing without anxiety, and many here find it a good antidepressant.
This is the end of the thread.
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