Adventures with Benzodiazepines and SSRIs

[David Baxter PhD]

That all sounds reasonable. Nothing to add.

 

[AmZ]

Thanks Dr Baxter.

Without me 'going off on one', could you perhaps alleviate some of my concerns of taking Paroxetine after I read all of these comments for example (I know, like we've said in the past, that the internet is not a good place to start looking up about medication and people's experiences can't always be trusted entirely, but that is a rather large majority of very negative posts) :

Reviews of Paroxetine

Is this medication more likely to have some side affects in the beginning and if so, one should just go with it until they wear off gradually and your body gets more used to the medication?

Thanks. Just want to know what I can possibly expect, and hopefully nothing at all asides from positive things!!

 

[David Baxter PhD]

Paxil isn't my first choice for SSRIs but I have seen it work extremely well for some people. With any SSRI, there is the possibility of what I call "adaptation effects" during the first 5-7 days while your body and brain adapts to having the drug in your system. The most common of these are lightheadedness, nausea, sleepiness, and "derealization" or "depersonalization" - a sense of wtaching yourself do things and feeling disconnected from those actions that rarely lasts more than 2 or 3 days.

Just remember that for every internet nightmare story there are hundreds of satisfied customers who don't go on the net to tell their stories. Who on those websites is interested in a story that says, "I started taking Paxil and it's great"?

 

[AmZ]

With any SSRI, there is the possibility of what I call "adaptation effects" during the first 5-7 days while your body and brain adapts to having the drug in your system. The most common of these are lightheadedness, nausea, sleepiness, and "derealization" or "depersonalization" - a sense of wtaching yourself do things and feeling disconnected from those actions that rarely lasts more than 2 or 3 days.

Cool, thanks. If it's just that we are talking about then I can deal with it and work through it. I guess it's also a good thing that (at least in the beginning) I'll be taking it in the evening with food, so as long as I sleep semi-decently at night (anyway, for 5 weeks I was only sleeping for 4 hours most of the time, and I'm still alive [duh]!) and sleeping through some of the side affects, then that's good also. Anyway, the feelings I was having with the anxiety were similar to this also, like the lightheadedness, nausea and feeling that I was somehow detached from my body, so I am semi-used to that and was still managing to function just about enough.

I know it's important to keep positive and not do the whole obsessive self-fulfilling prophecy thing that I've done in the past a bit... So I'm promising myself to get through it all and take all the advice and help I can get from the psychologist. (And here of course ;-) - Your forum and advice has helped a lot ty).

Trying to think of some other things also that I can be doing during the week to try and get myself 'better' - any ideas? Like I've said in the past, and I'm sure for like many people, 1 hour a week in therapy often doesn't feel like much at all when you have all the other days and hours in the week feeling that nothing else is 'helping'/working on (can't think of how to explain that exactly, sorry). Hope you get what I mean. Like the daily 'countdown' until the 1 hour - I am eager for it.

Just remember that for every internet nightmare story there are hundreds of satisfied customers who don't go on the net to tell their stories. Who on those websites is interested in a story that says, "I started taking Paxil and it's great"?

For sure. Agree.

Thanks again - Wish you a nice day... 5pm already here

 

[David Baxter PhD]

Trying to think of some other things also that I can be doing during the week to try and get myself 'better' - any ideas? Like I've said in the past, and I'm sure for like many people, 1 hour a week in therapy often doesn't feel like much at all when you have all the other days and hours in the week feeling that nothing else is 'helping'/working on (can't think of how to explain that exactly, sorry). Hope you get what I mean. Like the daily 'countdown' until the 1 hour - I am eager for it.

Ask your psychologist for some homework assignments.

In the meantime, you can start working on these:

http://forum.psychlinks.ca/cbt-cogn...lings-and-the-thoughts-that-control-them.html

http://forum.psychlinks.ca/cbt-cogn...y/1451-the-ten-forms-of-twisted-thinking.html

http://forum.psychlinks.ca/cbt-cogn.../18058-ten-ways-to-untwist-your-thinking.html

http://forum.psychlinks.ca/cbt-cognitive-behavior-therapy/5049-daily-mood-log.html
​

 

[AmZ]

Much appreciated.

Will take a look at those links later when I'm back from work.

---------- Post added July 14th, 2010 at 06:34 AM ---------- Previous post was July 13th, 2010 at 05:20 PM ----------

Howdy,

It's 6.30am here and have had the most interrupted sleep of them all - Don't think I slept for more than an hour at a time, just kept waking up and dozing off again for a while since 1am, now have given up trying to sleep in the meantime!

Any reason as to why the new medication mixed with the old one would make me less sleepy? I was expecting that my regular 1 Alprazolam and 10mg of the new med would actually do the opposite. Whilst I have felt relaxed and felt fine whilst I was waking up during the night and even now, I haven't felt tired which is unlike me.

With the side affects of the new med - I felt it a bit, but of course, nothing like I was reading on the other forum -- Just a couple of hours of a buzzy kind of feeling inside and my heartbeat racing a bit now and again. That's it

Anyway, it's all good... Not complaining (too much) - Just wasn't what I was expecting sleep-wise.

---------- Post added at 10:33 PM ---------- Previous post was at 06:34 AM ----------

Question... I take multivitamin and iron tablets - Didn't think about it, but could that be a problem at all with the medications I am on? (Maybe a silly question) Is there some way I can check now via the ingredients?
And if I took them today, and it's possible that there could be some problem, can I take my medication this evening?

Just something that popped in to my head and thought that would be worthwhile asking quickly.

Regarding not sleeping much also last night... I'm not worried about it right now, will carry on regardless, was just wondering if it happens to some people at the beginning or in general with this medication?

Thanks.

 

[Retired]

Is this medication more likely to have some side affects in the beginning and if so, one should just go with it until they wear off gradually and your body gets more used to the medication?

I stand to be corrected on this, but I am not aware of literature describing SSRI's (the class of medications to which Paxil (paroxetine) belongs to be associated with tolerance. Requiring an increased dose to achieve the same effect over time occurs with other medications, but not with SSRI's or SNRI's to my klnowlege.

Once the effective dose to relieve your symptoms is achieved, that is the dose on which you would remain indefinitely, or until your doctor would see a reason to modify the dose or change to a different compound.

Most important for people who take Paxil is to never stop (withdraw) this medication suddenly. It must always be tapered over a two to three week period if a stopping the medication is planned. Your doctor would provide you with the detailed instructions on the tapering schedule. Be sure your prescriptions are renewed in time in order not to run out and if travelling, make sure you have more than enough for the length of your trip.

This is just a characteristic of how Paxil is metabolized and in no way reflects on its effectiveness or how well it may or not be tolerated.

BTW I happen to be one of thos satisfied users of :rx: Paxil, which I took for nearly ten years. During that time my symptoms were relieved, along with supportive psychotherapy from my :doctor:. When it came tome to withdraw the medication, I followed my doctor's instructions for tapering and did not experience any unexpected adverse effects during withdrawal.

I have been medication free for nearly three years without any relapse of symptoms....:yahoo:

I hope you might find the same relief, AmZ

I take multivitamin and iron tablets - Didn't think about it, but could that be a problem at all with the medications I am on?

If I am not mistaken, you are taking paroxetine and alprazolam. If that is so, there are no listed interactions between multivitamins and iron supplements. If you are taking other medications or supplements, let us know and we'll run them through a reliable interaction checker, and let you know.

 

[AmZ]

First of all, many thanks for your reply Steve

I stand to be corrected on this, but I am not aware of literature describing SSRI's (the class of medications to which Paxil (paroxetine) belongs to be associated with tolerance. Requiring an increased dose to achieve the same effect over time occurs with other medications, but not with SSRI's or SNRI's to my klnowlege.

Not sure if we're on the same page as this, but maybe I just didn't understand your reply? I was asking specifically about that I had taken 10mg of Paroxetine for the first time last night, plus a full Alprazolam (0.5mg) - Asides from some side small side affects from the Paroxetine (but only in the first couple of hours really and nothing that would seemingly stop me from sleeping), I had a very bad nights sleep. Was wondering if 1. Paroxetine can generally do this? (With the possibility of it being a long term thing) and 2. If it can, whether it's a short term side effect that I can expect to pass? I was waking up every hour or so and just dozing in between and didn't get in to a deep sleep at all the whole night.
The psychiatrist had said that I will have 'some side effects' for probably the first few/several days, whilst my body gets used to the medication. I am on 10mg for the first 4 days, then going to 20mg after.

Most important for people who take Paxil is to never stop (withdraw) this medication suddenly.

Thanks for the advice. I tell ya, some people... Just look at those stupid YouTube videos and search on Google about the withdrawal off of Paroxetine, and no wonder why they had such a hard time coming off of it. For example "I took this evil drug for 10 years, 60mg a day. Then I went cold turkey. I stopped taking it altogether one day because I had stopped therapy. I have never experienced something so awful in my life, what a nightmare! DON'T TAKE THIS DRUG!!" -- Well, yes, no wonder why you went through that nightmare!!

BTW I happen to be one of thos satisfied users of Paxil

Very good to hear Steve... Happy it went good for you! And...

I have been medication free for nearly three years without any relapse of symptoms....

That is so great to hear also! Congratulations!

I really hope that I won't need it long term, or that's the plan. Things just got really bad real quickly. Never been in therapy or on medication my whole life, and just bang, hit me about 5 weeks ago and unfortunately couldn't control the physical anxiety, so here I am now... But trying my best to make the positive changes in my life now which should stop this and come out better the other end

If I am not mistaken, you are taking paroxetine and alprazolam. If that is so, there are no listed interactions between multivitamins and iron supplements.

Marvelous. TY. I am not on or take anything else. Now and again I take something for a headache here and there but think I checked that and I'll just stick to plain old Paracetamol and nothing more.

Thanks again for you positive and helpful advice!

 

[Retired]

I guess I misunderstood your querry, because I thought you were asking about long term tolerance; however that was not your question.

Your doctor may have explained there is an adaptation period with this type of medication, where the body and especially the brain chemistry becomes "reset", which is thought to be the reason for symptom relief.

During this resetting period, there is a possibility of experiecing some adverse effects such as somnolence and/or nausea and in some people agitation. Usually these subside after a couple of weeks, as the body becomes acclimated to the new medication.

However, it is a good idea to keep your doctor in the reporting loop of the adverse reactions you are experiencing, because, depending on the side effect, the doctor may be able to prescribe temporary relief from the side effect.

Certainly report the difficulty sleeping to your doctor if it persists after a few days, especially if you are taking the alprazolam at bed time, which was likely prescribed to help you sleep.

The doctor may choose to modify your dosing schedule or even to switch to a diferent compound.

FYI if your doctor opts at any time to switch to another SSRI or SNRI compound, and the switch takes place immediately, there is no need to taper the Paxil as has been mentioned, because the new medication will replace the Paxil.

Withdrawal is only an issue when the medication is withdrawn and nothing replaces it.

 

[AmZ]

Certainly report the difficulty sleeping to your doctor if it persists after a few days, especially if you are taking the alprazolam at bed time, which was likely prescribed to help you sleep.

Will do. I've been taking the Alprazolam already for a couple of weeks, with a week of that was at a higher dosage and also had changed to take it before I went to bed at night for a few reasons. I noticed the difference once I started taking it at night that I was sleeping better but since taking the Paroxetine the last two nights (now it's 7.30am here, same thing happened) I slept very badly, just felt like I was dozing on and off all night. (BTW - The Paroxetine was added only a couple of days ago as the 'plan' in the first place wasn't to be on a long/er term medication - Or that's what I had hoped.)

Concerning the other symptoms, I feel especially nauseous this morning and pretty 'rough' but I'm not going to look too much in to that because I've had this a LOT before also simply because of the anxiety itself and not necessarily now due to the side affects of the Paroxetine. One thing that was a bit weird especially last night was that only a short time after getting in to bed, (at least it felt that) as soon as I closed my eyes I was dreaming, but I felt like I was still totally awake! Physically and everything. The night before I had it also, and both of the dreams were quite unpleasant so hope that won't happen again anytime soon After the 'dreams', I 'woke up'/'opened my eyes' (whatever it is!) and just went back to laying there until I fell asleep again.

Right, it is officially that day of the week... Therapy day.
Then off to work.

Goodnight to the North Americans ;-)

 

[David Baxter PhD]

One thing that was a bit weird especially last night was that only a short time after getting in to bed, (at least it felt that) as soon as I closed my eyes I was dreaming, but I felt like I was still totally awake! Physically and everything. The night before I had it also, and both of the dreams were quite unpleasant so hope that won't happen again anytime soon After the 'dreams', I 'woke up'/'opened my eyes' (whatever it is!) and just went back to laying there until I fell asleep again.

Vivid dreams are common when starting SSRIs.

 

[AmZ]

Gotcha...

I'll just have to hope for some nice ones then... Because these are nasty so far!

---------- Post added at 01:52 PM ---------- Previous post was at 07:48 AM ----------

Is it worthwhile at all to take an anti-nausea medication (due to the side-effects of the new medication), or won't it help? Wondering if someone on here or your patients (Dr Baxter) have done the same thing and maybe it worked for them/you?

TY.

 

[Retired]

Is it worthwhile at all to take an anti-nausea medication

Check with your doctor before doing so, because these medications and their availability (Rx vs OTC) varies from Country to Country and the kind used may or may not interfere with meds you are currently taking. Some doctors prescribe certain anti emetics (anti nausea) medications to help get through the acclimation period, so check with your prescribing doctor on this.

While you are speaking to your doctor, you may want to report the vivid dreams you are having. They may or not be disturbing you, but your doctor should be aware they are ocurring. This information will help your doctor make decisions about your treatment options in the future.

From my own experience, I had vivid dreams on one medeication my doctor prescribed in the early years of treatment, and because I found the dreams to be disturbing and affected my quality of sleep, the doctor switched to a different compound...in my case, Paxil, which resulted in years of successful treatment.

Each of us responds differently to each of these medications, so fortunately physicians have choices in being able to choose from a variety of SSRI/SNRI compounds.

Keep the conversation going with your doctor, and through this partnership, the chances for successful treatment are significantly improved.

 

[AmZ]

Thanks.

Yes, the sleep thing in general is not going good since I started the medication 3 nights ago. Tonight (it's 5.30am now), I slept great for the first 4 hours, then woke up at 4.30am and can't get back to sleep now. I slept from 12.30am to 4.30am and there is no reason for me to be awake, just can't get back to sleep. My alarm was set for a nice-sounding 8am.... Ahhh, sounded good to me :-( No dreams (that I remember) tonight which is a good thing, but just not enough sleep obviously.

Was feeling pretty nauseous yesterday and just managed to eat at 3pm for the first time, and I don't know how I managed to keep my food down as I'd coughed during eating and had that nasty gag reflex thing and heaved a bit (sorry for the details!) but at least managed to keep my food down.

I've only been going through this with the psychiatrist so far so I don't know if he can help me with all of these things or whether it should be my family doctor instead/also. I went to my family doctor once about this and she just wrote me a letter of urgent referral back to the psychiatrist and told me to go there straight away to get things sorted out.

I don't expect to be side affect free but generally don't go good on a lack of sleep, so there is 'only so much I can take' of this one.

---------- Post added at 06:08 PM ---------- Previous post was at 05:31 AM ----------

There's no reason that I should be feeling worse today... But I am feeling awful and can't snap out of it. I'm really upset and in a bad place and don't know what do to.
Sucks.

Anyway. I'm sorry for all of the ranting on I do on here. I feel like a burden and annoying to everyone around me... and myself.

 

[David Baxter PhD]

You are going to have some ups and downs. No medication is going to take away all your anxiety - and that would not even be a desirable thing. The medication is to help you limit and better manage the anxiety. Additionally, the medications take time to work and cannot do the whole job alone - that's where your psychologist comes in.

In your case, your anxiety seems to manifest itself primarily in physical symptoms and is complicated by probable OCD. Talk to your psychologist about this and find out how he intends to address the OCD aspect.

Give the Paxil a chance to work. If you still feel the anxiety symptoms are not under control, consider talking to your psychiatrist about Luvox (fluvoxamine), which is better for OCD and obsessive anxiety.

 

[AmZ]

Thanks.

It's not even the anxiety and physical feelings that are the problem really... The more this has gone on, I've started to feel different things mentally and gradually things are coming out (all starting from JUST physical things to now where I am a couple of weeks later), I've just been feeling worse mentally.

Today I just feel the most unhappy I have done (extremely), agitated and feel just generally p***ed off with everything. I went out today and felt like I was a horrible person with no patience, waste of space and more.

Then the 'fix' I have been given by the psychologist is to go and make friends and it's not something I can instantly do, which just makes me feel even worse. Now I'm just left with this 'life coaching' and some medication. The session on Thursday made me feel worse than I was feeling before.

 

[David Baxter PhD]

The right fit between client and therapist is critical to progress in therapy. Talk to him about your concerns when you next see him. If you'r still not feeling confident in this psychologist, find another one.

All of your symptoms are entirely treatable. It's a matter of finding the right medications and the right therapist to help you manage the symptoms.

 

[Retired]

But I am feeling awful and can't snap out of it.

Try not to be so hard on yourself. As has been said, relief may not come overnight, and as for the bothersome adverse effects, you need a couple of weeks for your body to become accustomed to the new balance of brain chemicals.

It may help to look at the long term, remembering there will be some bad days but as time goes on there should be more good days than bad days. A strategy that has helped many people in dealing with the bad days, is to lay low and ride out the difficult time, in the knowledge it's only temporary and good days will return soon.

Persisting with your medications and following the advice of your therapist should lead to eventual relief.

 

[AmZ]

The right fit between client and therapist is critical to progress in therapy. Talk to him about your concerns when you next see him. If you'r still not feeling confident in this psychologist, find another one.

I will do so and see what he says. I'd told him already in the last session and like I say, he was just refusing to go in to the negative thoughts and reasons as to why I feel them. For whatever reason, I feel worse from not doing that. Now they just seem to be reproducing tenfold in my mind and getting worse and worse. Maybe his approach isn't good for me, or maybe I am yet to see/understand and it actually is - Just gotta wait until next Thursday to (grr) speak with him about this and come to a conclusion/solution.

Concerning the medication - It's something that as much as I like to try in avoid feeling, I still feel pretty bad about. I wish that I could have just controlled this by myself and maybe in getting the help and care I needed a few weeks ago and then it wouldn't have come to this. Maybe at least if the therapy felt better to me, then I'd feel better about being on medication as I'd feel like something is being fixed. But so far, just feel like I am waiting for the medication to work (especially now for the depression side of things) and nothing else. I am only 25 and have a fear of ending up having to take this for longer or at a later stage in my life. I'm just scared about this also. A whole life ahead of me.

I know there are going to be bad days along the way, just difficult in the meantime that I maybe only have a bad day every few days, but those bad days themselves are getting worse and worse every time I have one.

 

[David Baxter PhD]

Concerning the medication - It's something that as much as I like to try in avoid feeling, I still feel pretty bad about. I wish that I could have just controlled this by myself and maybe in getting the help and care I needed a few weeks ago and then it wouldn't have come to this.

Would you feel that way if you had diabetes or a thyroid condition and needed medication to control that illness?