Adventures with Benzodiazepines and SSRIs

[David Baxter PhD]

You still have the lorazepam, correct?

 

[AmZ]

Yes, but haven't taken tonight due to my stomach.

It's 4am now here... Just dozing on and off and being woken up by different things and still feeling very bad. Have muscle spasms and my teeth/jaw shut together now and again uncontrollably. etc.

---------- Post added at 05:21 AM ---------- Previous post was at 04:11 AM ----------

Tried again just sipping water and my body rejected that also... I can't keep any fluids down and starting to get the shakes and a headache.
9pm last night was sick, then midnight and now 5.30am also.

---------- Post added at 05:09 PM ---------- Previous post was at 05:21 AM ----------

Howdy,

Ended up getting very bad so went to the hospital in the early hours via ambulance and spent a few hours there. They did blood tests, urine tests, and ECG to check my heart as it was irregular and put me on an IV with some fluids.

Saw the hospital's psychiatrist (who I had originally seen all those weeks back) and explained everything. He says that I have mild Serotonin syndrome so no more of those meds for me!

Still feeling pretty bad and the IV they'd given me with the fluid, I think, gave that medication still in my blood system a good buzzing around so I felt very 'wired' after and shaking/over-energy both brain-wise! Was also sick when I came from the hospital also. Guess I have a few days feeling like this until the medication has left my system?

They said to go back to my psychiatrist on Sunday and see about a non SSRI med - So my question is, this sounds like a viable option and there are many to choose from and they are good? Thx.

Asides from that, it's possible that I may go back to England to get this sorted as it's too difficult here with lack of support and people to be around. In England I can be with my Father and his wife 24/7 and have all the help and support I need. We'll see about that anyway. May not be possible time-wise, as I still have a job and life here.

One more thing. I was given anti-nausea tablets and checked if they interact, and says they do:

Applies to: lorazepam & metoclopramide
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

I can still take these together?

Many thanks as always.

 

[Retired]

I was given anti-nausea tablets and checked if they interact

Would you specify the reference or the site where a potential for interaction between these two medications is indicated. I checked on reliable interaction checker I use, and found no interaction. Lorazepam is rarely associated with drug interactions because of the way it is metabolized, although there may be a mechanism of action with which I am not familiar. The only concern is when cental nervous depressants (not to be confused with antidepressants) are combined, there is a potential for drowsiness or other CNS efects, but these are not usually of major concern when correctly prescribed by the doctor.

Have either your doctor or pharmacist warned you about possiible inteactions?

 

[AmZ]

Hi Steve,

Thanks for the reply.

I looked it up on drugs.com - Drug Interactions

The doctor who prescribed me them in the hospital didn't warn me about any interactions with the Lorazepam. I haven't taken the anti-nausea tablets and don't know if I will be doing so, but still good to know in case. I hope they've managed to get a majority of the medication out of my system and am feeling quite a bit better.

Anyway, the fun goes on (!). I ended up spending 24 hours in the hospital. They had me wired up to check my heart and other things to keep me monitored due to all of the side effects.

Dr Baxter - Hope you are well ;-) If you have some free time I'd really appreciate if you could let me know a little about non-SSRI/SNRI's, now I know that I can't take these. Thx.

 

[David Baxter PhD]

See Prescription Anxiety Medications on RxList.com

Three or four options to treat anxiety:

• benzodiazepines like clonazepam or lorazepam which you already know about
• BuSpar (buspirone) - "an antianxiety agent that is not chemically or pharmacologically related to the benzodiazepines, barbiturates, or other sedative/anxiolytic drugs." - http://www.rxlist.com/buspar-drug.htm
• beta blockers - Beta Blocker Drug Class Information on RxList.com and Beta Blocker Drug Class Information on RxList.com
• older style antidepressant medications - Tricyclic antidepressants (TCAs) or Monoamine oxidase inhibitors (MAOIs) - Antidepressant Types, Uses, Side Effects, and Drug Interaction Information on RxList.com

 

[AmZ]

Thanks, much appreciated.

benzodiazepines like clonazepam or lorazepam which you already know about

Yes. But hoping not to take these for much longer of course, and need something for depression so am checking out the other links you provided me. - Specifically for anxiety & depression.

 

[David Baxter PhD]

Really, talking to your doctors would probably be more helpful. There are a few others I haven't mentioned for depression but they may have their own side-effectys. And you should be aware that the older style antidepressants have more side effects in general than the SSRIs - that's why the SSRIs are so popular.

 

[AmZ]

Thanks...

Yes, will be speaking to the psychiatrist on Monday.

Well, that kinda sucks for me

I guess there is nothing I can do... If they say that I have this 'Serotonin syndrome" and can't go on to try a 3rd SSRI and I'm left with other options which don't seem so viable either then not sure what the answer is. Definitely not worthwhile traveling back to England for also.

Maybe I'll just get to eating some of that dark chocolate and get in the sun for some of that Serotonin to be released :bonk:

---------- Post added at 11:00 PM ---------- Previous post was at 10:51 PM ----------

Just to clarify, in the case of not being able to take SSRI's, the same is also true of SNRI's?
The only reason I ask this is because the psychiatrist in the hospital yesterday had said that there are other options available to me such as Effexor - But when I look that up, it says it's an SNRI and also would therefore be a problem with the "Serotonin syndrome". Hmm?

---------- Post added at 11:17 PM ---------- Previous post was at 11:00 PM ----------

I'll stop asking these questions - Sorry... I know that this forum is not something in place of my doctor... Just on my mind now and wanted to ask.

Just starting to feel in that place of being 'doomed' again unfortunately. This time, even more so now I have failed [in] the medications (I was going to write that the medications failed me lol, but it's not their fault).

Trying to find some options and possible answers for myself.

 

[David Baxter PhD]

Just to clarify, in the case of not being able to take SSRI's, the same is also true of SNRI's?

The only reason I ask this is because the psychiatrist in the hospital yesterday had said that there are other options available to me such as Effexor - But when I look that up, it says it's an SNRI and also would therefore be a problem with the "Serotonin syndrome".

Effexor, Pristiq, and Cymbalta are actually dual-action SSRI/SNRI medications. Wellbutrin is not an SSRI but for some people with anxiety makes them feel more anxious or jittery.

 

[AmZ]

Effexor, Pristiq, and Cymbalta are actually dual-action SSRI/SNRI medications.

That's one for me to Google! Don't understand about 'dual action' etc etc and what the differences are, but yes, I remember him saying that they are a 'mix' - But he said that Effexor would be a viable option for me but that he didn't want to prescribe it then and there and that I should just go back to my psychiatrist on Sunday/Monday.

Guess I have a hundred and one questions (as usual!)... First of all, if Effexor is still an SSRI based medication (at least in part) and I had such a reaction to those 'straight-up' SSRIs, then just scientifically, I wonder how this works and therefore how it could be OK for someone to take in my situation?

 

[David Baxter PhD]

I am really not certain.

Rather than worrying about it in advance, AmZ, why not just rest assured that there are several options, some we haven't even discussed, and these you will work out with your psychiatrist when the time comes?

 

[Retired]

By dual action, in the case of SNRI wich means Serotonin Norepinephrine Reuptake Inhibitor, it means the medication targets the reabsorption of the two neurotransmitters, serotonin and norepinephrine, the two neurotransmitters thought to be associated with the illness of depression.

SSRI meds are designed to specifically target serotonin only while having virtually no effect on other neurochemicals, of which there are several. Older antidepressants did not have this targetted approach, mainly because the technology for designing them only came into existence in the early 90's. Consequently their effect was much broader, affecting neurotransmitters such as adrenergic and muscarinic neurotransmitters, which can result in many and often bothersome side effects. Many of these bothersome side effects are overcome with the use of SSRI's and later with the introduction of SNRI's.

There is a close relationship in the machanism of action of SSRI's and SNRI's because of their design, and SNRI's were developed later after SSRI's had been available for several years.

If your doctor feels Effexor (venlafaxine) might be an option for you, I would encourage you to give it a try. There are many doctors who feel there are clinical benefits to this medication plus it seems to be well tolerated by many who use it. Additionally there are important reasons from the way this medication is metabolized in the body to make it an attractive option.

One thing to bear in mind, that if your doctor offers Effexor as an option to you, it is extremely important that when you are ready to stop taking this medication, that it be tapered gradually and not stopped suddenly. It happens to be another medication with a short half life, and requires gradual tapering on discontinuation, unless it is replaced with another similar medication. Ia m sure your doctor and/or pharmacist will provide you with detailed instructions.

There is virtually no potential for this drug to interact with other medications, because of the way it is metabolized, as was said earlier.

'Serotonin syndrome"

Has this been the official diagnosis by your psychiatrist for the adverse effects you are currently experiencing? Are you currently taking other medications that affect serotonin such as a triptan for migraine? Other than the minor tranquilizers like lorazepam are you taking other prescribed meds, herbal preparations or any alternative medications (prescribed or over the counter)?

If indeed there is a possibility of serotonin syndrome in your case, your doctors are your best resource on how to proceed.

 

[AmZ]

Rather than worrying about it in advance, AmZ, why not just rest assured that there are several options, some we haven't even discussed, and these you will work out with your psychiatrist when the time comes?

Yep, sorry. Am just as eager as always and frustrated (this has been going on a while already and has been highly unpleasant of course ;-) ) and also maybe I got the wrong impression from your earlier post as it didn't seem that I had many options left.
If you are saying that there are more options then that puts my mind at rest of a bit. Thx.

Steve, thanks for all of the information - Much appreciated. I understood everything. I'll need to wait to see what my psychiatrist says at the clinic I go to and see what his opinion is of what could be good for me. I'm still seriously looking at going back to England for a couple-few weeks to get this sorted there but need to look my health care back in England and how quickly I can get seen there and get medication and also to make sure of any other problems or reasons as to why I wouldn't be able to get treated there and then come back to Israel.

Has this been the official diagnosis by your psychiatrist for the adverse effects you are currently experiencing?

Yes, the psychiatrist told me this when I was in the hospital and it's on the discharge papers also for my family doctor and psychiatrist, it's written that I have "mild serotonin syndrome".

Are you currently taking other medications that affect serotonin such as a triptan for migraine? Other than the minor tranquilizers like lorazepam are you taking other prescribed meds, herbal preparations or any alternative medications (prescribed or over the counter)?

I don't take any other medication. The only thing I've also taken recently is Paracetamol for headaches, but nothing else. The last time I took something else than just Paracetamol was probably months ago, and even then, I don't think it was one of the medications that would be a problem for me now.

---------- Post added at 02:25 PM ---------- Previous post was at 08:42 AM ----------

How about Wellbutrin as a viable option out of the several?

Just reading up before going to the psychiatrist tomorrow.

---------- Post added at 02:42 PM ---------- Previous post was at 02:25 PM ----------

Trying to keep myself worry and anxious-free at my return to work today, but so far, 4 people have said how much weight I look like I've lost, especially in my face... my cheek bones ... Not good. Yikes.

 

[David Baxter PhD]

How about Wellbutrin as a viable option out of the several?

Answered previously:

Effexor, Pristiq, and Cymbalta are actually dual-action SSRI/SNRI medications. Wellbutrin is not an SSRI but for some people with anxiety makes them feel more anxious or jittery.

 

[AmZ]

Thanks. Forgot about that.

Def not needing any more anxiety or jitteryness ;-)

I'm starting to question again if something could be physically wrong with me. Whether it seems silly to be questioning or not, I don't know. The more this has gone on and the more weight I am loosing, I am starting to worry myself, regardless of all the comments at work which are making it worse. I know that on one hand, obviously, I haven't been eating much in the last 5 weeks but you know, sometimes, you have a gut instinct about your health.. plus with the lack of appetite all the time. Blood tests have been done, ultrasound on my stomach has been done and stuff, but not sure if something else could be a problem.

Whatever the problem is, I just feel worse... and that's the thing, it could be either anxiety/depression (getting worse) or a physical illness - But with still no meds to get working on the one possibility of anxiety/depression, I can't count anything out. Then the sessions with the psychologists haven't helped me see enough if the anxiety/depression is really that bad to be causing such physical symptoms. On the other hand, I don't know what else my family doctor can do. They just checked my vitals and said they were OK and sent me to the psychiatrist.

Sorry, just a bit upset about this.

 

[David Baxter PhD]

I think you are totally in the middle of a "cycle of anxiety" currently, where feeling anxious triggers more anxiety. Add to that increasingly obvious OCD symptoms and you've got obsessive worrying making it all even worse.

 

[AmZ]

You're right I know.

I just don't know what to do with myself.

Funny thing is... You are the only one who has been 'lucky' enough to see this all pieced together here and understands it best. And I'm still where I am when this started 5 weeks ago. Only thing that changed is that I feel worse.

---------- Post added at 04:23 PM ---------- Previous post was at 04:02 PM ----------

On the bus on the way to work today I had a thought that it doesn't matter whether this is sorted out or not any more because that I have some kind of premonition that before it is sorted out, I will be in a bad accident (no details provided!) anyway. That's where I have come to in this. Just feel hopeless and starting to think really badly about everything. I'm starting to give up.

What does someone do in my situation now after all of this has happened? I don't know.

 

[David Baxter PhD]

I just don't know what to do with myself.

For now, keep taking the lorazepam as directed. When you have nausea, take the Gravol or whatever you were given. Then follow up with the psychiatrist.

You are the only one who has been 'lucky' enough to see this all pieced together here and understands it best.

Try printing this thread and taking it along with you to your appointment with the psychiatrist.

I'm still where I am when this started 5 weeks ago. Only thing that changed is that I feel worse.

That's really not true. You've learned quite a bit in the interim:

• it's not a virus
• there is no other physical cause
• you cannot tolerate Paxil or Zoloft
• you probably are not a good candidate for SSRIs in general
• you exhibit clear tendencies toward OCD

On the bus on the way to work today I had a thought that it doesn't matter whether this is sorted out or not any more because that I have some kind of premonition that before it is sorted out, I will be in a bad accident (no details provided!) anyway. That's where I have come to in this. Just feel hopeless and starting to think really badly about everything. I'm starting to give up.

That's classic OCD worrying and pessimism kicking in.

What does someone do in my situation now after all of this has happened? I don't know.

CBT.

 

[AmZ]

For now, keep taking the lorazepam as directed. When you have nausea, take the Gravol or whatever you were given. Then follow up with the psychiatrist.

Am doing so. Not sure whether it is still the Paxil/Zoloft in my system. Took them for a total of 9 days and last took it Thursday afternoon. Most of the nausea has gone so I don't need to take that med. Just have a 'funny head', can't really explain it. Out of it. But not sure if it's just because I switched to the Lorazepam and am taking it at night as well as 1mg in the morning... Feeling extremely tired at work and can hardly keep my eyes open. So yeah, will go with it, maybe it's the SSRI's still in my system a bit and/or the Lorazepam which I switched to which may be making me more dozier than the previous Benzo.

That's really not true. You've learned quite a bit in the interim:

•it's not a virus
•there is no other physical cause
•you cannot tolerate Paxil or Zoloft
•you probably are not a good candidate for SSRIs in general
•you exhibit clear tendencies toward OCD

I'll try to bear in mind these positives -Of course, to me, they don't really feel like positives, just either things that I tried and that didn't work or OK, I can admit, the only good thing is that I came to the realization that the "virus" was not a virus and was anxiety, then adding on the OCD realization, great, and add on some depression and frustration and lots of other emotions and feelings also... At least I can call them 'negative steps forward' which I hope will be reversed once I start to make some 'positive steps forward'. - Just feel like I've mainly just progressed in feeling worse and nothing much else. Nothing has 'worked' or 'helped' me and then when I thought that I had come to the final solution of taking medication (already nearly 2 weeks ago now), it's hit me back in the face. Now back to feeling worse and needing to wait longer for another solution.

Don't know in which order to do things... Psychiatrist tomorrow but then my Father wants me to go back to England, I see pros in that, but cons also, I just want to get moving in some other direction also to get a solution! Once again, just the confusion over and over.

That's classic OCD worrying and pessimism kicking in.

Yup.

CBT

To end on a positive note... lol... Sorry, it's not going to be one. Again I just #*^%ing don't know where to get the help I need! I went to three private psychologists, weren't for me. Even if I now know more what I need i.e. to specifically ask for CBT, I have the two options as to how I can get to these people, and both are as difficult as each other...

And if I go back to England for a few weeks max, then all I can rely on there is the medication and to wait for that to start to work, then come back and start the ball rolling with the psychologist. But maybe I need that now?

I don't know myself in which order to do things so am left with advice from other people, but can't say that there ideas sound great either.

Really either way feel like I could just lose my mind or have a total breakdown.

 

[Retired]

Wellbutrin is not an SSRI but for some people with anxiety makes them feel more anxious or jittery.

Def not needing any more anxiety or jitteryness

Note that David states that some people experience these effects using Wellbutrin (bupropion), but a large proportion of the population experience symptom relief. If your doctor feels it might be right for you at this time, it should not be ruled out as another option in finding the right medication that could work for you before giving it a trial.