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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 Dispossessed on April 28, 2015, at 19:43:09
Hello,
Ever since discontinuing an SSRI a couple of years ago I have experienced some form of akathisia/agitation - sometimes its bearable, other times its not - and is preventing me from working and doing a lot of other things. My initial diagnosis was OCD (Pure O) and neurotic depression.
My current meds are as follows:
20mg fluoxetine. I've tried pretty much every other SSRI - they all didn't agree with me, making me extremely restless etc. Fluoxetine is the 'least worst' of all the SSRIS - it has the greatest antidepressant effect (possibly due to 5HT2C antagonism) and generally helps the OCD even at this dose. However, has caused moderate to severe sexual dysfunction.160mg propranolol. Limited effect. Taking it to counteract activating effects of SSRI. Few side effects.
300mg pregabalin. Worked well at first then seemed to wear off. Sexual dysfunction.
3.75mg mirtazapine. Helped me sleep, slight improvement regarding restlessness. However, weight gain even at this low dose. So I'm coming off it.
The question I am asking is what should I replace the mirtazapine with? I'm thinking either something like 25mg trazodone (for its 5ht2a antagonism) or 5-10mg amitryptline.
The main symptoms I am trying to treat are:
- restlessness and inability to sit still
- muscle pain
- sense of dysphoria
- jaw clenching and sleep bruxismI also have a number of other issues like poor concentration/memory and sexual dysfunction, but to be honest I'd prefer to get this agitation/akathisia/restlessness/whatever it is under control. Benzos would work well but sadly in the UK, the NHS will not prescribe them for long-term use any more.
Thanks a lot for your help!
Posted by Christ_empowered on April 29, 2015, at 9:59:09
In reply to What(non benzo) med for chronic akathisia/bruxism?, posted by Dispossessed on April 28, 2015, at 19:43:09
ummm....well, how do you feel about supplements? b6 in high doses has been used for tardive everything. More Tardive dyskinesia than akathisia, but its been used for akathisia, too. Its cheap, so I thought I'd throw that out there.
Neurontin? Lyrica? Depakote?
Posted by Lamdage22 on April 30, 2015, at 10:04:56
In reply to Re: What(non benzo) med for chronic akathisia/bruxism?, posted by Christ_empowered on April 29, 2015, at 9:59:09
Im sorry SSRI did this to you.
So folks, the irreversible stuff that certain members want to warn you of here is real!
Posted by Lamdage22 on April 30, 2015, at 10:09:57
In reply to What(non benzo) med for chronic akathisia/bruxism?, posted by Dispossessed on April 28, 2015, at 19:43:09
I would have to say that you are damaged enough as it is.
Passion flower?
Posted by Lamdage22 on April 30, 2015, at 10:32:56
In reply to What(non benzo) med for chronic akathisia/bruxism?, posted by Dispossessed on April 28, 2015, at 19:43:09
Dont torture yourself anymore. Who is saying you are supposed to do this??
Posted by Dispossessed on May 1, 2015, at 19:49:36
In reply to Re: What(non benzo) med for chronic akathisia/bruxism?, posted by Christ_empowered on April 29, 2015, at 9:59:09
> ummm....well, how do you feel about supplements? b6 in high doses has been used for tardive everything. More Tardive dyskinesia than akathisia, but its been used for akathisia, too. Its cheap, so I thought I'd throw that out there.
>
> Neurontin? Lyrica? Depakote?Thanks for your reply. I was taking lithium orotate (10mg elemental lithium) and it may have been responsible for me having a good spell over Christmas. I cut it back to 5mg - or it could have been because I drank a bit of alcohol over Christmas - and the agitation came back. So maybe I could try that again but at say 20mg. I dunno. I haven't tried B6 in high doses but part of me suspects that SSRI akathisia/withdrawal akathisia differs from antipsychotic akathisia (maybe the latter has more of a physical, can't sit still component whereas the former also contains a significant psychological component - I dunno).
Pregabalin is Lyrica - I take 300 a day (was on 150 a day until last week). It really doesn't do much apart from give me orthostatic hypotention and even more sexual dysfunction. Seemed to work for a week and then pooped out. Probably the most useless medication I've ever taken to be honest.
Posted by Dispossessed on May 1, 2015, at 19:57:32
In reply to Re: What(non benzo) med for chronic akathisia/bruxism?, posted by Lamdage22 on April 30, 2015, at 10:04:56
I don't think it is irreversible, just may take a long time (couple of years) to go away. I was experiencing a lot of cognitive problems and visual snow which has greatly improved. I will just give it time and maybe at some point in the future I can do a slow taper off my SSRI. At the moment I'm just seeking something to cover the mirtazapine withdrawal - I was only taking 3.75mg for the past few months (now down to 1.875) but feel that its serotonin antagonism has helped with the restlessness. So I'm thinking a tiny dose of trazodone would help - really just for the 5HT2a antagonism. With mirtazapine I'm having massive carb cravings which probably isn't doing anything for my healing journey.
As for passionflower? Its a possibility, but I generally don't get much of a relief from GABA medications for some reason. Benzos don't really help - not unless I crank the dosage up greatly and then I have issues such as sedation, cognitive impairment and of course the risk of tolerance.
Posted by Lamdage22 on May 2, 2015, at 11:00:04
In reply to Re: What(non benzo) med for chronic akathisia/bruxism?, posted by Dispossessed on May 1, 2015, at 19:57:32
is passion flower GABA??
I love lithium orotate!
Posted by Horse on May 7, 2015, at 16:42:13
In reply to What(non benzo) med for chronic akathisia/bruxism?, posted by Dispossessed on April 28, 2015, at 19:43:09
NAC?
Posted by phidippus on May 7, 2015, at 22:18:59
In reply to What(non benzo) med for chronic akathisia/bruxism?, posted by Dispossessed on April 28, 2015, at 19:43:09
Propanalol or cogentin for the akathisia. Mirtazapine for the OCD-its well studied.
Eric
Posted by jrbecker76 on May 13, 2015, at 11:27:13
In reply to What(non benzo) med for chronic akathisia/bruxism?, posted by Dispossessed on April 28, 2015, at 19:43:09
I would stay away from Trazodone or Nefazodone. The m-CPP metabolite (a 5-HT2c and 1b agonist) will very likely exacerbate your dysphoria, inner-tension, and restlessness. As you're probably aware of, the commonality to all of your symptoms has to do with poor dopaminergic actitivity in one form or another.
I wear a nightguard for my Citalopram-induced bruxism and it seems to work pretty well...not the more direct solution you're probably looking for but it definitely prevents teeth grinding and less daytime jaw tension.
I'm honestly surprised you prefer Fluoxetine given that agitation and restlessness is considered more prevalent on this drug than others in the SSRI category. Duloxetine was a low offender for me with these issues if you haven't given it a go yet.
Have you ever tried fish oil? There is some evidence that it can enhance certain dopamine related symptoms (e.g., tardive dyskinesia, attention deficit, etc).
I was also on low-dose Mirtazapine for years and although I did find it great for sleep, I was surprised to find that I was less restless and inner tension off of it than on it. My belief is that although its antagonism for 5-HT2a/2c benefits the issues you suffer from, the alpha-2 noradrenergic effect very likely adds to restlessness/agitation in particular. I'm optimistic you'll make strides in this area if and when you indeed come off of it.
Sorry I don't have a better answer for you.
Posted by SLS on May 30, 2015, at 17:09:16
In reply to Re: What(non benzo) med for chronic akathisia/bruxism?, posted by jrbecker76 on May 13, 2015, at 11:27:13
What do you think accounts for the bruxism you experience with citalopram?
- Scott
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