Adventures with Benzodiazepines and SSRIs

[David Baxter PhD]

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.

What you decribe sounds very much like SSRI discontinuation syndrome. The fatigue isn't surprising considering the toll of the medication reactions plus anxiety plus sleep deprivation.

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.

...

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?

Assuming you are a UK citizen, and depending on how long you might remain in the UK, you could get started on both medication and CBT over there, and then look for practitioners locally to continue that work when you return.

 

[David Baxter PhD]

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.

Thanks, Steve. You are, of course, correct.

 

[AmZ]

What you decribe sounds very much like SSRI discontinuation syndrome. The fatigue isn't surprising considering the toll of the medication reactions plus anxiety plus sleep deprivation.

Yea, feeling pretty wrecked. Have to admit, I managed to eat when I was with my family on the weekend, and now I feel really anxious today because I turned up at work with everyone saying how much weight I had lost, it made me anxious and was difficult to eat lunch. Really need to make myself eat later when I get back from work.

Assuming you are a UK citizen, and depending on how long you might remain in the UK, you could get started on both medication and CBT over there, and then look for practitioners locally to continue that work when you return.

I have dual-citizenship yes. But I can only go for max 4 weeks (and don't really even want to be there longer than 3 weeks even), because my "life" is back here and I still have a job, rented apartment, etc that I need to get back to. Really, the only thing I'd be able to do in England is get on some medication and be around my Father and Step-Mother 24/7 so have the support and care. Therapy-wise, I can't spend enough time there in order to start that.
Ideally, I'd be able to go and get a new med tomorrow from my psychiatrist here and also find a psychologist tomorrow and 'sort out'/'set-up' everything in one day - But again, I don't know how the medication will go and even how the new therapy which I will find will go... I don't expect it to be any different, even though I'd like it to be, but a one hour session a week for me is like nothing. I guess more importantly is to find a suitable medication. But I know part of the problem, and a big thing, is that I am doing this by myself... So, then I am back to the idea of going back to England... But there are pros and cons on each side... plus, goodbye to my savings in the bank, the flights cost a fortune and I'd be off of work for a month... Just can't even decide myself what is best to do. If I knew the medication would be OK (just take it and no side effects, wait for it to work for a couple of weeks) then fine, but I am concerned that the same thing may happen again and I'll be going back around full circle, or how it feels to me anyhow.

---------- Post added at 06:18 PM ---------- Previous post was at 05:46 PM ----------

Anyway, I'll go to the psychiatrist tomorrow and see what he says.

I don't expect to get all/any of my answers from here, but you guys do give good advice so thank you.

Just again trying to balance what to do between what I know if/will be good for me vs. the things I'd like/prefer to do, but may not be good for me. Plus not to 'disappoint' or go too much against my family's advice - They expect and want me to go back to England. But doesn't mean that I have to of course. Still in two minds about this. More on the no, but I know that everyone (my family) will disagree with me on this. MMM. Anyway.

What is the jaw/teeth grinding to do with? My jaw is hurting so much! Kept waking up during the night with my teeth grinding together and when I was waking up and falling back to sleep during the night my mouth was snapping together without me being able to control it.

---------- Post added at 08:51 PM ---------- Previous post was at 06:18 PM ----------

And out come the anti-nausea tablets :red:

 

[Daniel E.]

What is the jaw/teeth grinding to do with? My jaw is hurting so much! Kept waking up during the night with my teeth grinding together and when I was waking up and falling back to sleep during the night my mouth was snapping together without me being able to control it.

Generally speaking, with most people, it's most likely from anxiety. I would inquire with your psychiatrist about increasing the dose on the benzo at night.

Alternatively, it could be SSRI-induced bruxism. But since you are off SSRIs now, I guess the only possibility left regarding SSRIs would be withdrawal symptoms.

Until the teeth grinding issue is resolved, wearing a mouth guard during sleep could help prevent tooth damage, though it may not help prevent jaw pain (or other TMJ symptoms like popping or crackling sounds at the joint when you open your mouth).

In the meantime:

Try simple self-care practices such as eating soft foods, using ice packs and avoiding extreme jaw movements, like wide yawning and gum chewing. Short-term use of over-the-counter or prescription pain medicines may also provide relief.

http://forum.psychlinks.ca/medical-...-is-often-best-in-treating-tmj-disorders.html

 

[AmZ]

Thanks for the links.

Thing is, I've only had it the last 2 nights... so not sure as to whether it is a coincidence that it's just as I come off the SSRI's that it's happened only now. At least haven't noticed doing this whilst sleeping in the last few weeks.

Sucks as I had a brace put on my bottom teeth a few months ago and have a few months left... I am snapping down so hard, my top teeth are colliding with the brackets on my bottom teeth... that isn't good! Both not good for my top teeth and for the possibility of breaking off the brackets also.

Anyway, somehow is the last of my worries but is annoying.

I definitely am avoiding at all costs the rising of the Benzo dosage. What are the problems in taking it for longer than a month? If I understood correctly, it can lose it's effectiveness after this time so you then anyway have to up the dosage and thought I had read about a couple more cons, but can't quite remember...

 

[Daniel E.]

my top teeth are colliding with the brackets on my bottom teeth... that isn't good!

In addition to possibly increasing the dose of the benzo, it seems you need to get a mouth guard, such as from your dentist. It certainly wouldn't hurt to call your dentist's office, which is certainly advisable.

In the US, at least, what is usually done is that the dentist makes a custom mouth guard costing hundreds of dollars (which is a lot cheaper than the possible dental damage). But we now have Walmart and pharmacies selling $15 mouth guards for bedtime use, so most people seem to go this route. We also have dental labs providing custom mouth guards via eBay.com (strange but true).

Anyway, somehow is the last of my worries but is annoying.

I definitely am avoiding at all costs the rising of the Benzo dosage

Your worries about benzos are misplaced, IMHO, especially considering that TMJ tends to be a chronic condition if further stress on the TMJ joint is not prevented.

If I remember correctly, we are talking about hundreds of pounds of force being placed on the teeth and at least sometimes even the gums.

 

[Retired]

rising of the Benzo dosage. What are the problems in taking it for longer than a month? If I understood correctly, it can lose it's effectiveness after this time so you then anyway have to up the dosage

You are describing a phenomenon that occurs with certain medications termed tolerance.

You stated earlier the doctor prescribed Ativan (lorazepam) as a minor tranquilizer to be used at this time. There should be little concern for tolerance to this medication in such a short period of time. With this medication, according to reports, tolerance may be seen only after many years of continuous use at uncommonly high dosages.

In your case, you would probably be well advised to follow your doctor's recommendation to help control the symptoms for which it was prescribed.

 

[AmZ]

Wish I had a Walmart here!

I'll have to look in to some alternate option - Getting my thinking cap on. I'll check in the pharmacy to see if there is anything they may have. Still a bit far back here product-importing-wise unfortunately!

Your worries about benzos are misplaced

I was talking in general about taking Benzos and the cons for taking the medication for longer than the 'suggested' month which I've seen a lot about. But OK, I guess you are saying that the cons of taking Benzos long-term outweighs the cons of TMJ? That's your point?

Is there no way that this can be just a withdrawal symptom from the SSRI's though? Or just a big coincidence? I hope that the doctor was right when he said that the withdrawal symptoms or left-over effects of the SSRI's should last for 3-4 days. Maybe then if the jaw clinching is due to this, then it may go in a couple of days...

---------- Post added at 09:55 PM ---------- Previous post was at 09:46 PM ----------

Thanks for the reply Steve.

I just wanted better to understand why I had read and was told by the psychiatrist that ideally it shouldn't be used for more than 4 weeks. Unlike other medications where I haven't heard this being the case, so why Benzos specifically? Maybe I am wrong here, I'm just asking. Anyway, there is nothing I can do in the meantime. The plan was to be on this for 3-4 weeks whilst the SSRI kicked in and then come off of this, but that hasn't happened. I've been on it for coming up to a month. I still need this for the anxiety and now need to find something new for depression & anxiety so that I will come off of this at some point.

 

[Daniel E.]

Also, I would keep a copy of this with me when seeing the psychiatrist:

Clonazepam, 1 mg 30 minutes before bedtime, significantly improved bruxism and sleep quality by objective and subjective measures

http://www.currentpsychiatry.com/pdf/0803/0803CP_Article1.pdf

 

[Retired]

was told by the psychiatrist that ideally it shouldn't be used for more than 4 weeks.

The ultimate guide should be your personal physician's advice, whose judgement you trust and who understands your situation, your medical history and your diagnosis.

While prescribing information for these medications in the sixties and seventies originally recommended benzodiazepines be prescribed for a four to six week period, physicians regularly evaluate their continued use on a patient to patient basis. It is not unusual for people to continue using a benzodiazepine for months and years with no adverse effects, while continuing to relieve their symptoms.

Granted there is controversy among some physicians as well as advocacy groups on the use of minor tranquilizers, which is why one needs to determine the benefits vs risks in a conversation with their own doctor.

I don't know what the prescribing regulations might be in the Country in which you live, which may also affect your doctor's position.

 

[AmZ]

Thanks for the info.

 

[Daniel E.]

As I have mentioned before, exercising more during the morning/day can help. In some studies, at least, exercise has been as effective as benzos for helping with sleep. So it seems combining 30+ minutes of sweat-inducing activity during the day with anti-anxiety medication at night could be especially effective for some people.

 

[AmZ]

I was put on Benzos for anxiety and not as a sleep aid.

However, I actually joined the gym just a week before all of this started, (as I used to do a lot of sports but am not as fit now as I used to be so joined for enjoyment/general health-wise) but have only managed to have gone several times unfortunately. Due to the lack of appetite/eating, I haven't had the energy and then once I started with the SSRI's, well, that was something else... Being sick, terrible headaches, appetite went even more etc...

When I did go to the gym I really enjoyed it and look forward to going back. Just looking now as to the medication I can be put on and sort out my appetite (amongst other things) and then should be good to go.

 

[Daniel E.]

As you may know, there are nutritional drinks like Ensure, Boost, etc. that are relatively high in calories (like 250 calories for every 8 ounces) and are generally tolerated well (even by nursing home patients and often even cancer patients).

When I did go to the gym I really enjoyed it and look forward to going back.

In the meantime, stretching or yoga may be an option that doesn't burn as many calories while still having anti-anxiety effects. Stretching is also good for nighttime anxiety since it doesn't interfere with sleep like evening exercise can.

 

[AmZ]

Funny you say this, I've been asking around to try and get some Ensure drink or something of the sort, and it doesn't seem to exist here!

The best alternate I ended up with were some imported American nutrition bars which are specifically for eating before/after working out.

My night time anxiety is actually OK... Just the morning and the rest of the day until late afternoon/early evening is the problem.

Anyway, a lot to sort out, but will get there eventually ;-)

 

[Daniel E.]

My night time anxiety is actually OK... Just the morning and the rest of the day until late afternoon/early evening is the problem.

To be clear, though, engaging in relaxation techniques can still help mitigate future anxiety even if you aren't anxious at the time you do them. This is especially true with cognitive self-help methods like "cognitive defusion" and "cognitive restructuring." Also:

Remember that relaxation techniques are skills. And as with any skill, your ability to relax improves with practice. Be patient with yourself ? don't let your effort to practice relaxation techniques become yet another stressor.

http://www.mayoclinic.com/health/relaxation-technique/SR00007/NSECTIONGROUP=2p

BTW, this lists yogurt with fruit as a more natural alternative to Ensure: The Scoop On Nutritional Energy Drinks: Ensure, Boost, Carnation Instant Breakfast

 

[AmZ]

Looks like it's going to be Reboxetine for me... But not starting it yet.

 

[David Baxter PhD]

I've not seen that prescribed before but it appears to be an SNRI, not an SSRI or dual action drug, so that sounds like a good one to try for you.

 

[AmZ]

Exactly yea.

I hope it will be good for me.

Plan of action is tomorrow morning to get back to the psychiatrist and get the medication. Then go to work. Ask my boss for the immediate leave off of work. Book my flights back to England. Fly back on Wednesday. Start medication there on Thursday. Will need to ask the psychiatrist here if he's OK with giving it to me even though I will be in England taking it and will be there for a couple of weeks. If I go back to England without it to start with then it's going to take time to get appointments and get the medication so more convenient and quicker this way. At worst, I have full coverage in England as I am a British citizen, so have doctors and hospitals there obviously if I need help with the medication etc.

I need some serious recuperation and a break. Need to catch up on sleep and catch up on eating and be taken care of. Have lost too much weight and feel too weak over the last 5 weeks of this. I can't be independent anymore and now need to be dependent on others to look after me a bit. Can't do it anymore.

That's the plan. Hope my boss will be OK with it and everything else will go to plan.

 

[Retired]

Reboxetine.....appears to be an SNRI

That is correct, as it's a Selective Norepinephrine Reuptake Inhibitor, however to call it an SNRI could be potentially misleading, particularly iin North America because the manufacturers of the dual action drugs like venlafaxine and duloxetine have branded their medications as SNRI's.

The North American dual action (serotoning and norepinephrine) offerings are described as Serotonin and Norepinephrine Reuptake Inhibitors, therefore SNRI..... not to be confused with Selective Norepinephrine Reuptake Inhibitors like Reboxetine.

To date there have been no selective norepinephrine reuptake inhibitors approved for use in North America.

They are all selective in their mechanism of action, as they have all been designed to target specific neurotransmitters. The only potential for confusion is the convention that has been adopted for naming these medications.

A selective norepiniphrine reuptake inhibitor is like an SSRI selective serotonin reuptake inhibitor, except that it targets the other (single) neurotransmitter thought to be associated with the illness of depression.

A previous Psychlinks discussion on Reboxetine can be found HERE