The Closest Thing To Crazy

[jordan]

Well, today was my initial appointment with a therapist.

I went early and filled out the appropriate paperwork and then met with the therapist for approximately 45 minutes.

For insurance purposes she had to come up with an general diagnosis which can be refined later.  Basically, she assigned general anxiety disorder to me.

I will see a psychiatrist who will hopefully recommend some medication to help me feel more at ease and maybe help with fatigue - not sure. 

Originally, the earliest opening was in October which I said was unacceptable.  Ergo, I'm going to another office in Ann Arbor which has a few more doctors on staff - the appoint is the first week in August.

At the end of the session it was agreed that I would meet with my therapist weekly.  My next appointment is next Wednesday.

So I need advice, because several years ago I did try Wellbutrin and more recent in February of this year I tried Paxil for about a week before I decided it was worse for me than just facing 'real life.'  The ironic part is that my infectious disease doctor referred to Paxil as "Happy Pills" - now that's crazy (I certainly didn't feel happy...more like listless and undigested).

What should I ask the psychiatrist for  - I don't want another SSRI - but should I be so bold or just say I need a sedative?

I would like something to ease the pain.

[Robert]

Hi Jordan.

Well, I'm on 20mg of Prozac/day.  It's not bad.  Every once in a while I'll take an extra pill if I know I'm going to be really stressed out.  Side affects aren't too bad, in fact I really can't think of any except maybe no sexual drive but I can blame that on the virus or the meds.  Who knows?

Good luck.
robert

[Andy Velez]

Hi Jordan,

Will you be having more than one appointment with this person? I'm wondering if rather than you suggesting drugs you can have some substantive conversation about where you're at and get a professional opinion on what might be most helpful to you.

In my opinion taking mood-altering pharmaceuticals ought to be temporary since it deals with symptoms and not causes. I do appreciate how painful feelings can be at times.

Please keepus posted on how this goes.

[jordan]

Robert:  check your PM (in a worse case I'm willing to try Prozak)


Hi Andy:

I'm going to be seeing the therapist once a week.

the psychologist only once

I just don't want the psychologist to recommend something that will not work.  I know they are the expert, but I know myself....I need something to keep me calm.

I'll keep you posted. 

Peace,

Jordan

[lydgate]

Buspar is often prescribed for GAD, as is Effexor. The latter, though, at low doses, works like an SSRI. Jay

[David_CA]

Hi Jordan,

I take 10mg of Prozac for anxiety.  I didn't realize that I even had it; my ID Dr. figured it out by my describing how I'd been feeling for a while.  I took on on Friday and by that Monday, I could feel a difference.  Later that week, I felt great... better than I had in a long time.  I felt like my carefree pre-HIV self, which was wonderful.  I've been taking it for about two months now and have only had one panic/ anxiety attack.  The sexual side effects are there, but they're an ok trade-off for how good I feel all the time.  I still function fine, but I just don't have the motivation.  Sometimes it takes FOREVER to get there.  I also take Adderal and I'm not sure what interactions the two might have.  I hope whatever you try works as well for you as Prozak does for me!  Take care.

David

[Jeffreyj]

Hi Jordan,
I would talk to your  psychiatrist  and tell him what you just told us, about the bad experiences you have had. Just be as up-front and honest, see what he says then. Having HIv/aids is tough because it effects everyone different. So be patient. Trial and error seems to be the norm with HIV. I wish you all the best.

[Life]

Jordan,  congrats on taking things in hand and moving with this...  Let the docs help you figure out what you need.  I for one have been usig Paxil (which takes up to 2 weeks for it to start benefiting the subject).  You may have stopped to soon.   I started taking this a year or so ago and it stopped me from roominating about everything..  It helped me.   Again,  stick with your doc on this one and let them help you make some decisions in feeling better.   Hell, Px's may not even be warrented once you get started...

Hope for the Best!

[whizzer]

In the case of the older SSRIs, such as Paxil and Prozac, it takes about a month for significant changes in the seratonin levels to manifest, that is, it takes that long for those drugs to work.  Any changes earlier than about three weeks are usually written off as placebo effect.  Not to say there is anything wrong with placebo effect, after all, any port in the storm, so to speak.  What is important is it is not unusual NOT to feel better within a week, and yet some of the side effects of the drug can present that quickly.  Unless the side effects are intolerable, it takes a month to give these medications a fair trial.

If you rule out all SSRIs, then you are pretty much left with Wellbutrin (which moderates not seratonin, but norepenephrine/dopamine), or the older Tricyclics, which have major, major side effects.

There are newer SSRIs which have less negative, though still very much present, side effects, and they do work somewhat faster.

Paxil is, however, the SSRI that has the best results in reducing anxiety along with depression.  However, if anxiety is present without depression, then maybe an anti-anxiety drug is in order.

If your chief complaint is fatigue, why would you want a sedative?

Of course, talk therapy alone can go a long way in reducing anxiety, without any side effects at all, other than an increased tendancy toward introspection.

The best thing is to get evaluated by the Psychiatrist and get a diagnosis before deciding which pill, if any, to pluck out of the pillbox. 

-Whizzer
(who has taken Paxil in the past and currently has been taking Wellbutrin for 5 years)

[Eldon]

Hello Jordan, it is Eldon. You are not alone when it comes to anxiety/panic attacks. My psychiatrist has me on Lexapro for anxiety and Reisperdal at night. She too diagnosed my first visit as GAD. Lexapro keeps me calmer than usual and sometimes I feel extremely tired. Not lately, as I put in another post, my anxiety has been costing me some restless nights for sleeping. Somehow I have developed a sleeping disorder? Can't quite sleep well at night like I used to.

I can relate to what you and others are going through and anxiety is no fun. I asked about Paxil and she (my psychiatrist) said it had a blackbox and basically she told me no in a nice way. I also see a therapist every other week and we have a chance to sit down and talk about what is going on in my life. It does some good when you are to talk things out.

When you do go to your appointment just be honest about what you are feeling and the Doc will have a better idea on how to treat you.

I wish you the best, and calm down.

[kiki06]

Good for you for taking charge and going to see someone to get yourself some help. I've had a long history with depreesion/anxiety medications, pretty much since I started the HIV journey back in 96.

When I was first diagnosed I was put on Prozac to help me deal with everything, that along with counseling I was able to stop after about a year.

Now more recently (within the last about 3 years) I have been diagnosed with anxiety/panic disorder along with a variety of OCD (obsessive compulsive disorder). I have been taking Paxil 20mg up until I needed a increased dosage in March of this year. I went up to 25 mg of the CR and now I am taking 50 mg of Paxil. I also have a prescription for clonazepam which can be used for breakthrough anxiety attacks. I carry this in my purse at all times but rarely have to use it.

I have in the past also used Lexapro which has supposed to have reduced sexual side effects (used this when I was with my ex but now it's not an issue  ) but after using Prozac, Lexapro, and Paxil I find that the Paxil CR helps control my moods and reduces my anxiety alot.

I wish you the best of luck in finding what works for you, it isn't always easy. If you need an ear who has been there feel free to PM me.

Good luck.

Kiki

[edfu]

Jordan, my psychiatrist put me on Celexa, which helped with depression but did nothing for anxiety and panic attacks.  If you don't want an SSRI...my psychiatrist then put me on clonazepam (Klonopin) 1 mg per day (although you can take up to 4 mg per day) and alprazolam (Xanax) 0.5 mg AS NEEDED (but no more than 1 mg per day).  This has helped greatly with anxiety.  However, since I'm sure many will jump in here to warn you, I will tell you first that there are issues of dependency and withdrawal with these benzos.  I will also tell you that my psychiatrist told me, after my pressing him on this issue, that he would not be concerned with this at the level he prescribed.  So this is a decision you must make with the psychiatrist.  For me and others who have experienced full-blown panic attacks--with excessive heart beating, cold sweats, difficulty breathing--it is worth the possible negative effects.

[lydgate]

Jordan,

A week is certainly too short for Paxil's benefits to show up; unfortunately, it's not too soon for the side effects to show up as well. Can you tell us specifically what made you stop taking it?

Wellbutrin would be a good non-SSRI option but it can make some people feel "wired" and make them more anxious. At therapeutic doses of Wellbutrin (300 mg) I have a lot of jitteriness and a lot of anxiety. Fewer problems with the XL version; and certainly some people respond well at a lower dose or don't have unpleasant side effects.

The other non-SSRI option is Remeron; there's a separate thread on that. Potential for heavy sedation and weight gain. Another is Trazodone; that's mainly used now for insomnia. I would avoid TCAs if possible.

Basically, anything that works for depression will probably work for anxiety as well, and many agents are used to treat anxiety disorders on an "off label" basis. In my opinion, all these happy pills have roughly the same efficacy in treating anxiety; its just that the makers of Zoloft, Paxil, Effexor, Celexa/Lexapro, and Buspar performed clinical trials to demontsrate this efficacy to the FDA. Now, with sales of Cymbalta lagging, Eli Lilly is performing trials to have it FDA-approved for GAD and other forms of anxiety. The sucky part is that finding the drug -- if you're definitely taking a psychopharmacological approach -- that's the best "fit" for you is sometimes a lengthy trial-and-error process.

I think taking a sedative/benzo is a pretty complicated decision. They're certainly fast and extremely effective. (Xanax in particular is the closest thing I've seen to pure magic [if I believed in magic]. It' scary how effective it is in treating my anxiety; I use it with a lot of caution; I have no desire to get hooked.) I've written elsewhere how a lot of doctors can be benzo-phobic. In your case, I'm assuming you want a sedative/benzo for three reasons: to make you feel calm rather than un-calm; to help with one of the presenting symptoms, irritability; and as a bridge of sorts until the long-term agent (Paxil or Buspar or whatever) starts to take effect. Klonopin is preferred by many physicians because it has a longer half-life. The right benzo for you depends on your specific problems and needs.

Kiki, this is what I do with clonazepam (Klonopin) and alprazolam (Xanax) -- just keep them around, rarely use. Knowing they're there makes me feel safer, the way that some people feel safer having a gun in the house. Also, doses for treating OCD tend to quite a bit higher than the doses used to treat depression and/or anxiety, so 50 mg of Paxil is not really a high dose (in your treatment). Are you having significant sexual side effects at this dose?

Eldon, do you know why your doctor prescribed Risperdal (and what dose)? It's a pretty strong drug, used mostly for the treatment for the mania part of bipolar illness and for schizophrenia. I think all the atypical antipsychotics are horse tranquilizers; so I'm a bit surprised that you take it at night and still have insomnia.

Robert, I'm not sure taking an extra dose of Prozac when you know you're going to have a stressful day is the best idea. The SSRIs (and other anti-depressants) aren't what are called "TNR" drugs -- take when needed; they don't work that way. And Prozac has a very long half-life, so doubling your dose for one day will cause a spike in the levels of Prozac in your body for several days. Finally, 40 mg of Prozac can actually cause jitteriness, anxiety etc. If you just need something just once a month, say, to help you get through a wretched day, a benzo like Ativan etc would seem more logical (assuming they don't make you sleepy).

Andy, I get the gist of what you're saying but... sometimes treating symptoms is the only option we have. I've had all the talk therapy I can possibly stand, literally thousands of hours; I put my eggs in the drug basket now. And nobody is clear how ADs work; there is a lot of talk, though, that they have neuroprotective effects, so that's getting closer to causes. Certainly, psychotropics are not for everyone and definitely not a panacea. With that caveat, I think the complaints that we're a Prozac nation, overloaded on happy pills, are silly. There is probably an under-diagnosing of of clinical depression (for a bunch of different reasons). I tend to be on the "pro-active side, the "aggressive" side in the treatment of mental illness. Throw whatever physical maladies you want at me, Life; it's the psychological crippling that I can't deal with.

If anyone has any questions or comments they'd rather not post on the main thread, feel free to PM me.

Two related threads from earlier:

http://forums.poz.com/index.php?topic=1846.0

http://forums.poz.com/index.php?topic=214.0

And see also Ann's most recent blog entry.

Jay

[JustAGirl]

I take 30mg of Prozac the only side effect I have noticed is no sexual desire when mentioned to my doc she put me on a low dose of wellbutrin but I stopped taking the wellbutrin and have just stuck with the Prozac which I know works for me! I am actually thinking of contacting the doc again and having it upped to 40mg.
I say just really be honest with them let them know what has and has not worked in the past they are there to help you!!!

I wish you the best!

Tiffany

[krakerjm]

I've gone thru a half dozen antidepressants in five years.  Yes they help. but as Andy said, not a cure.  Little depression and anxiety is nothing to panic over, it's those sudden heart racing moments and crying jags for seemingly no reason that need help.  I hate counceling and have so far avoided it using script drugs; but sometimes wonder when I too will feell like a nut case and seek help.  I don't trust tharapists anywho...