Adventures with Benzodiazepines and SSRIs

[Retired]

I'm going to demand to see the psychiatrist in the morning and switch or do something because it's not bearable.

Agreed! When experiencing adverse effects with a new medication to the extent you have been describing, it only makes good sense to get back to the doctor to review your situation.

These medications can cause some discomfort, as we have discussed, during the the initial couple of weeks, but when the adverse effects are debilitating, then a follow up conversation should be had with the doctor.

Make some notes before your visit, to detail exactly what adverse effects you experienced, how long they lasted and how they affected your ability to function. This will help not to forget any details.

This information will help the doctor understand how you respond to Paxil and should provide some insights into how to best proceed.

 

[AmZ]

Thanks Steve.

It really does feel that bad. Even now, to be honest, I feel like I need some sort of medical attention, like going to the emergency room. It doesn't feel right. I managed to eat some rice this evening and even now I feel really not good. I'm sweating and my breathing is shallow - As much as I can be told that the breathing thing is due to anxiety, I honestly don't feel that anxious. My body just feels weak and have tingling/buzzing inside. I've got weird pains also in the inside of my arms (the area from where you get blood taken from). I've been laying here feeling pretty relaxed just trying to take it easy and it's a really weird feeling but my heartbeat really slows down as soon as I start to doze off a bit and my breathing slows down. I'm not sure what happens, but it's like I'm skipping a breath or a heartbeat and then I 'wake up'. I know that if I go to the emergency room, there is nothing they're really going to be able to do, so no point I guess.

There is really a part of me that just doesn't want to take any medication, but I know that I need something... and for something to start working for me as soon as possible. As much as I explained to the psychiatrist on the phone today about my symptoms, he just said to give it more time. He's going to have to trust me on this that I am not 'over-egging the pudding' and that I do really feel that bad so I don't have any more time to wait and see an improvement and something needs to be changed now.

---------- Post added at 11:35 PM ---------- Previous post was at 11:02 PM ----------

Weird rash on the top of my left arm also, couple of inches wide. Came up an hour ago or so and it's still there a bit, but better... lol, what a mess I am.

 

[David Baxter PhD]

Weird rash on the top of my left arm also, couple of inches wide. Came up an hour ago or so and it's still there a bit, but better... lol, what a mess I am.

AmZ, that's usually not a good sign at all, especially in combination with the other symptoms you're describing. I think you may be having an allergic reaction to the medication and you should take this seriously.

I strongly receommend that you go into ermergency and get yourself checked out. Take it from the voice of experience: If you are starting to show signs of an allergic reaction, anaphylaxis is not fun.

 

[AmZ]

Woke up with the sweats, headache, feeling faint, nauseous and rash on my arms. Just got back from the emergency room and they just gave me anti-histamines and said that if it was an allergic reaction to the medicine, it would have shown earlier. I've never had any allergies to anything in my life so seems like a bit of a coincidence to me. Plus I've been in my house for 3 days, haven't even been out and bought something new (like washing powder etc etc) or eaten anything new, so I don't see how that's the case. But again, that's what the doctor says, so what can I do but argue a bit and try to explain my best!? About the side effects from the Paxil, he had nothing to say asides from to go back to the psychiatrist and speak with him about it.

Now will be the fight no doubt with the psychiatrist this morning. Got to call him in another 1 1/2 hours to speak with him first on the phone and see if he will 'agree' to see me.

 

[David Baxter PhD]

Just got back from the emergency room and they just gave me anti-histamines and said that if it was an allergic reaction to the medicine, it would have shown earlier.

Absolute balderdash. I have had delayed allergic reactions to medications (i.e., only appearing after several days to a week or even longer) more than once in my life.

 

[AmZ]

I know.

This is just so overwhelmingly frustrating, it's making me feel even worse.

It's like nobody is listening to me.

No doubt, the psychiatrist today is going to say to carry on with the Paxil. I'm just point blank saying no, regardless of his reaction, which no doubt isn't going to be a nice one because I am disagreeing with him.

If this is an allergic reaction then about about the other SSRIs? The same will not happen with those?

This is so dumb!

 

[David Baxter PhD]

No, allergic reaction or not, the way you've reacted to Paxil does not mean you'll react badly to other SSRIs.

 

[AmZ]

Then I'll just demand to move to something else and hope that the next one will be better.

Thx for the help - You are literally the only doctor making sense in all of this!

Another day I'm going to have to call in sick and just lay here all day. Sucks. My work are getting agitated with me, but there isn't much I can do about it... Or at least, what there is I can do, I AM TRYING!!

 

[Retired]

AmZ,

You are going about this in the right way, by collecting information from reliable and credible sources. Sometimes, unfortunately, you need to be your own best advocate in your own health care. Information is power, and by collecting the right information, you can ask the right questions, and provide the right insights to your medical practitioner.

Sometimes medical systems are under so much pressure, the overworked professionals staffing these facilities don't have the time to ask all the right questions of their patients. That's where the well informed patient can work in partnership with their health care provider.

As David has already alluded to, your reaction to Paxil in no way predicts how you might respond to another SSRI/SNRI compound. People either experience adverse reactions in the form of side effects, or in rare cases they may experience what doctors refer to as an idiosyncrasy to the product, which is essentially an allergic reaction. It is possible for individual allergic reactions to just about anything, some being less common than others, so the possibility cannot be ruled out.

When you see your psychiatrist, ask, that considering the difficult time you have had over the last few days, that you be prescribed different compound in the choices of SSRI's or SNRI's. Your doctor should be able to offer alternatives.

 

[AmZ]

Many thanks for your support and advice Steve - Much appreciated. Same to everyone also of course

Of course, another interesting day in all of this, what else!?

Went to the psychiatrist. Explained everything. He first said that because of all of the side effects from the Paxil, I need to stop it. Agreed. But then he said that for 2 reasons, he doesn't want to put me on a new SSRI. 1. Because I was so sensitive and couldn't take the first one and 2. I am not eating enough. He said that if I'm not doing this basic thing, then he can't give me another medication to take and that's probably why the side effects were worse also.
He said that I can either go home just with a 'better' and/or higher dose of Benzodiazepine and no SSRI and join their 'in-take' clinic next week where you go there most days of the week for activities/therapy and go home at night or that I can be 'hospitalized'. By being hospitalized, then I can be monitored as to how much I am eating etc and be given medication or at least be in a place where I have support and am not in my apartment by myself (for most of the time) for another crazy amount of weeks not being able to leave much and function.

Tried arguing my corner that none of these options are really viable. The only semi-viable one was being hospitalized, and I left thinking that that was what I had to do. Didn't want to go home. Sat outside for a while and thought about it and just made me feel worse again to be honest, like I am back to square one. Called my sister and she came to meet me and went back to speak with the psychiatrist to find another solution. Was definitely good to have my sister there as I seem to be pretty bad it seems in getting what I need (!) and generally, having two people (still mainly my sister) in there 'all guns blazing' was needed.

Story goes on but basically he agreed in the end to give me new medication on the agreement that I 1. Make more of an 'effort' to eat and to work on that and 2. That I am around people more so that they can see I am eating and see my general situation.

So as busy as my sister is with a 2 week old baby and more things like in the middle of moving cities etc etc, and even more etcs to put on the end (such as me not being able to stay at her apartment as her in-laws are visiting the country now) - This is the agreement we came to. So I got my new medication and went back to hers and just hung around for the day - I know that I have to do this more, even though there isn't much to do there and the last thing I want to do is just sit there all day thinking about all of this that is happening. But still better to be around people and do that, rather than to be alone doing it.

So my new meds are:
From 20mg Paxil to 50mg Sertraline (Zoloft, Lustral) - 25mg for the first 4 days and then 50mg on the 5th day. Then once the 50mg starts to work, move to 100mg a day.
From 1.5mg Alprazolam to 2 x 1mg daily Lorazepam


As always, tips, advice or any positive (or negative mg input much appreciated!

 

[David Baxter PhD]

That sounds like a step forward to me, AmZ. Good for you for going back and getting him to listen! :2thumbs:

 

[AmZ]

Thanking you

BTW, he told me not to bother with the psychologist for now and just wait a couple of weeks for the medication to start to work and then see about therapy. Probably best to be honest as I can't really say what I did was helping, (and if it was, mmm, well, I may be saying differently now haha)... But I can go with that.

Concerning the side effects of the SSRIs, they can last up to a couple of weeks and that shouldn't be a concern? (Of course, asides from things like rashes etc!) - I only say this because I took the new medication this afternoon and have the olde sweats and headache again after several hours of taking it - Not as bad as with the Paxil, but still... I can expect maybe another 7 days of side effects and just go with it as long as they are bearable (of course)?

 

[David Baxter PhD]

Concerning the side effects of the SSRIs, they can last up to a couple of weeks and that shouldn't be a concern? (Of course, asides from things like rashes etc!) - I only say this because I took the new medication this afternoon and have the olde sweats and headache again after several hours of taking it - Not as bad as with the Paxil, but still... I can expect maybe another 7 days of side effects and just go with it as long as they are bearable (of course)?

That's quite possibly just the effects of Paxil (discontinuation effect) still. Taking the Zoloft will help offset the discontinuation effect. Give it a week or so, anyway, if you can. With any luck you'll start feeling a little better sooner than that.

 

[Retired]

Glad to hear you are exploring different options and that you were able to have this dialogue with your doctor. Will be looking forward to know how you progress.

You may have talked about difficulty in your nutrition, but I probably missed it. What obstacles are you dealing with in that regard?

 

[AmZ]

That's quite possibly just the effects of Paxil (discontinuation effect) still. Taking the Zoloft will help offset the discontinuation effect. Give it a week or so, anyway, if you can. With any luck you'll start feeling a little better sooner than that.

Thx.
I hope -- ahh, just want things to go right now. But I know there are still chances that it may not so not going to convince myself either way!

I like how the psychiatrist seemed to have a light bulb light up and said "I have a good SSRI for you. Zoloft. It has much less side effects than Paxil!" -- Merci!!! That's true then?

Another question if I may?
If you look at two types of SSRIs, does/how the amount of milligrams of medication correlate to each other? (If that made sense!?) -- I only ask this because I was going to be on 20mg of Paxil and now am going to be on 50mg-100mg of Zoloft. That's a lot of milligrams difference whereas it seems that with the Benzodiazepines, usually the dosage amount is around the same.

---------- Post added at 10:33 PM ---------- Previous post was at 10:16 PM ----------

Glad to hear you are exploring different options and that you were able to have this dialogue with your doctor. Will be looking forward to know how you progress.

You may have talked about difficulty in your nutrition, but I probably missed it. What obstacles are you dealing with in that regard?

Thanks Steve.

Regarding the eating issue. It's been something that started from day one (5 weeks ago since this started). I don't know really 100% what has gone on, but can kind of see. When I was waking up in the mornings with the bad stomach, it was first of all due to anxiety - I could only manage to drink liquids and get an appetite in the early afternoon and then eat a sandwich or something, still a lot less than I would normally eat. Even though then I was given the Alprazolam for the anxiety, I'd take it in the morning, and still my appetite wouldn't come on until the afternoon and still not be eating much. When I feel like I couldn't eat, I had tried a couple of times, and I literally was just chewing on it and couldn't swallow it.
Then alongside starting the Paxil last week and also to be honest, in feeling more depressed than before, my appetite went all together. I guess that it was partly due to the side effects of the Paxil as I was feeling very nauseous in the morning until late afternoon, and in general, all of the side effects made me lose my appetite. Plus, never in the day did my stomach start to rumble, it just felt full all the time which it wasn't like before. On the other hand, I was mentally feeling worse and gradually over the 5 weeks it's come to me not having a desire for any food at all, there is nothing I want to eat and also, just feel like most of the time I can't and simply don't want to eat. Whilst I was on the Paxil, at least until the evening, even the idea of food literally turned my stomach. and before, and it's still like this in the morning until lunchtime at least.
I guess it's all just a mix of anxiety, depression and the side effects of the medication.
It's kinda difficult, and even now, I still can't bring myself to eat solid foods in the morning and later too (only milk or a yoghurt drink), but I'm really going to have to try and sort this out somehow, as otherwise, I won't be following Dr's orders! Hope that at least I can get back to before when I was managing on a liquid breakfast and eating lunch about 1pm and something in the evening also. Not sure what else I can do about this asides from just tell myself that it's all power of the mind and just eat! Kinda tried that and it didn't work most of the time... Think I just need to go with it and be more strict on myself and work on it more, especially if I want this medication to work and not be hitting a pretty empty stomach.

 

[Retired]

does/how the amount of milligrams of medication correlate to each other?

It's a good question and one that is frequently asked.

Each compound has its own "potency" for lack of a better term, that is established through clinical testing to determine the best dose to relieve symptoms, while keeping side effects at an acceptable rate, all the while ensuring the dose is safe.

Once these doses are established, they are approved by the local regulatory agency governing medications within a given Country.

Eventually tables of approximate equivilant doses are established to assist doctors in switching patients from one medication to another, while maintaining the approximate equivialant therapeutic dose.

So an analogy often used to describe this concept is to consider an ounce of whisky versus a pint of beer. The dose (ounce vs pint) is considerably different, but the effect might be about the same.

It's understandable that when you felt the way you have been the last few days, there would be limited apetite. Consider simple things, like an egg with dry toast, or a small portion of meat or fish with some green veggies. Another option could be liquid meal supplements that you might find at your local pharmacy. Thes can provide a balance nutritional supplement (including fibre) during your time of readjustment.

Ask your pharmacist about meal replacement products such as Ensure (perhaps sold under a differnt name in your area).

Many people make their own smoothies, that are tasty, refreshing and nutritional.

Be sure to hydrate yourself though, drinking plenty of water every day.

 

[David Baxter PhD]

Approximate equivalents for different SSRIs

SSRI | Dosage equivalents
20 mg | Celexa (citalopram hydrobromide)
10 mg | Cipralex/Lexapro (escitalopram oxalate)
75 mg | Effexor (venlafaxine hydrochloride).
10 mg | Lexapro/Cipralex (escitalopram oxalate)
50 mg | Luvox (fluvoxamine maleate)
20 mg | Paxil (paroxetine hydrochloride)
20 mg | Prozac (fluoxetine hydrochloride)
50 mg | Zoloft (sertraline hydrochloride)

One study has shown that Celexa (citalopram hydrobromide) is the best intermediary drug when rotating SSRIs. Technically, Effexor (venlafaxine hydrochloride) is not an SSRI but rather a dual action SSRI/SNRI.

 

[AmZ]

Look what the cat dragged in eek:

Each compound has its own "potency" for lack of a better term...

Very interesting. Thank you for taking the time to explain everything to me. And thanks Dr Baxter for the table information... Not only am I building up enough of a knowledge of these medications, I also have enough medication to start my own pharmacy! Clonazepam, Alprazolam, Lorazepam, Paxil and Zoloft. I hope there won't be any more new ones coming in to the list!

Ask your pharmacist about meal replacement products such as Ensure (perhaps sold under a differnt name in your area).

Funny you mention this. I've been searching for exactly this, and it doesn't seem to exist here! I asked in a couple of pharmacies, and they said all they can recommend are multi-vitamin tablets lol - Maybe I'll start a franchise

Many people make their own smoothies, that are tasty, refreshing and nutritional.

Ah, back in the days where I actually liked food and had an appetite, I was making smoothies... Not so long ago... Maybe 3 months ago. Well, going to have to get the blender out of the cupboard again and get back to those, as I agree, they are good, filling and nutritious also.

Be sure to hydrate yourself though, drinking plenty of water every day.

Totally yeah. That's one thing I have been doing. It's been around 90?F here for a week or two and now it's staying for the summer also. That has made things tougher for me, need more energy and lose it (and liquids) quicker etc. Anyway, can't change the weather, so will have to just deal with that one!

Today's update: Took the Zoloft yesterday afternoon and the Lorazepam an hour before I went to bed last night. Slept max 5 hours, including my weird 4am wake up for no reason. (Or so it seems). Only thing I had in the morning was feeling a bit nauseous, but felt better after an hour or so. REALLY want to get back to my life and wanted to go to work today so made a deal with myself that in order to go to work, I first need to eat breakfast. 8.30am, hoorah, I had some toast and was OK. (That Paxil 'did in' what was left of my appetite!). So went to work (and still here, 8pm), had some vegetables and cheese for lunch, and a yoghurt and my appetite has been better today. But have to get home now to eat something else, as it's not enough, I know. Going to be 10pm by the time I get back, oh well. Head is hurting in places here and there, just from the medication, weird, but not that bad. Have felt kinda 'wired' at work, and my boss who sits in front of me probably things I'm on speed or something! Anyway, he knows what's going on, so that's good. Eyes closing falling asleep feeling v tired, but mind and head is buzzing around like crazy, can't focus at times, eyes/vision jumping around... I can physically feel the medication doing it's work up there! Just hope it hurries up and continues!

So far, so OK.... A lot better than the Paxil!
Can't say that I am looking forward to going to the 50mg (from 25mg) in 2 days time - If when I take the last 25mg dose before upping it, I just hope that the 50mg won't be like what happened with the Paxil. Basically in my side effects being doubly as worse! But hey, we'll see what happens.

So far, the Zoloft has been much better for me it seems.

 

[Retired]

they said all they can recommend are multi-vitamin tablets

Glad to hear you are making positive progress. Successful treatment comes gradually, sometimes with occasional setbacks, but overall, hopefully you will notice some relief of symptoms.

Of course, multi vitamins won't supply the nutritional needs you require. Products like Ensure and Boost (Brand names sold in North America) have been formulated to actually replace meals for people who, due to physical illness or other limitations, cannot eat ordinary food. The brand used in most hospitals and approved for meal replacement is Ensure, made by Abbott Laboratories.

I'm surprised Abbott does not have distribution in your Country. Speak to your doctor about liquid meal replacement, and ask what is used in hospitals in your area.

You need to determine your daily caloric requirement, because one can of these products only supplies a small amount of one's daily calorie needs.

I would stay away from diet food preparations, health store products and non medically supported meal replacements. Because hospitals use this kind of product routinely, your best course of action would be to inquire from your doctor, ask at a local hospital or at the pharmacy inside the hospital (hospital pharmacist) or hospital dietician.

 

[AmZ]

OK, things changed in a matter of hours.

I took the first dose of Zoloft yesterday at 4pm and the second at 4pm today at work. Coming back at 9pm on the bus, start to sweat, get a pain on the right inside of my arm, narrow breathing and was sick. Back to the place I was at for my rash the other day, they tell me that my body has rejected the medication. About the pain/numbness in my arm (which I still have 3 hours later), they said that the medication affects the nervous system and has affected that part of my body. Told me to obviously stop taking the medication until I see the psychiatrist which can only next be on Sunday now.

Now I am back home, still feeling nauseous, tingling/pain sensations in my head, constant narrow breathing, pain in my arm, sweating... Feel awful.

---------- Post added at 11:53 PM ---------- Previous post was at 11:28 PM ----------

Don't know what to do with myself.

Also now my stomach is messed up, I can't keep fluids either.

But seems that I am left with laying here again feeling v bad and nothing I can do about it. To know what to do right now is most important. And I don't know what to do.

(Secondly, I don't think I can try a 3rd med. But that's not even something that I want to think of now.)