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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by cab on November 10, 2002, at 17:34:37
I'm feeling incredibly horrible, with extreme agitation, feeling of terror constantly, extreme hopelessness, etc. I have a couple of questions -- 1) I've been on Paxil 20 mg for 3.5 weeks (after slowly moving up from 5 mg), and it wasn't helping my depression at all (which wasn't this bad until a couple of days ago). My pdoc now wants to try another 4 weeks with a higher dosage (up to 40 mg if I can handle it). Has anyone had an experience of not responding at all to a regular dose of paxil or another SSRI and then responding well to a higher dose?
2)Since this horrible horrible anxiety started a few days ago my pdoc put me on 10 mg zyprexa (benzos don't touch it). OK, I know it sounds dumb, but many of you have been in my position -- my other question is, WILL THIS GET BETTER? Is there any real chance it won't? I mean, do people ever stay like this forever? (Before this I had 2 completely happy, normal years.) If I thought this wouldn't change I would kill myself right now. So I just need some hope to hang onto. Any of your stories about feeling terrible and hopeless and feeling like it wold never end, and then getting better would be GREATLY appreciated. Thank you so much.
Posted by Dinah on November 10, 2002, at 18:07:03
In reply to Please, please help, posted by cab on November 10, 2002, at 17:34:37
Hi cab,
You really need to check with your pdoc about whether the anxiety and agitation could be caused by the increase in Paxil. That happens sometimes. Sometimes it's a start up side effect that you can get past with the short term help of a benzo or some other anti-anxiety medication. But SSRI's aren't for everyone. Sometimes the side effects don't go away. Please have a serious talk with your pdoc.
Good luck, and make sure your pdoc really understands how you feel.
Dinah
Posted by xjs7 on November 10, 2002, at 19:09:57
In reply to Please, please help, posted by cab on November 10, 2002, at 17:34:37
Hi Cab,
First of all I'm sorry you are feeling so horrible right now.
Zyprexa is not mainly used in the treatment of anxiety. It and other antipsychotic agents can help alleviate severe anxiety, but they are more commonly used in psychotic conditions and mania. Could your feelings of terror be a sign of paranoia?
I have a psychotic condition and as part of my condition I experience some of your symptoms, such as agitation and feelings of terror. If you have a similar condition, Zyprexa might help you a lot. The one good thing about this sort of illness is that it is highly treatable.
I hope this helps and that you feel better soon.
xjs7
Posted by JonW on November 10, 2002, at 19:34:37
In reply to Please, please help, posted by cab on November 10, 2002, at 17:34:37
Hi cab,
I've suffered from severe depression and anxiety (social phobia) most of my life. It started getting bad by the time I was ten. I've been suicidal off and on since then. This past year I was hospitalized twice and was the worst I have ever been. During this time I had commited suicide so many times in my head that carrying it out was no more than a technicality. In fact, I felt dead already. I know what it's like to live without hope, and yet, for some reason continue breathing. It's a war between the instict to stay alive and the need to end the physical, palpable pain of an intractable depression.
I hope you can relate to this and find hope in my progress. During the worst of times, if someone told me the pain would be gone in a day, that was too much to bear. I needed to be done with it yesterday. However, I managed to stay alive and I'm glad I did. It's very important to understand that feeling hopeless is part of the illness, and while suffering from depression you may be incapable of thinking clearly about certain things. If things aren't going well it can be to your benefit to listen to the advice of others that have your best interest in mind.
An unfortunate reality in healthcare is that you get what you pay for. My advice to you is to seek out the best pdoc you can afford. I would then have that pdoc recommend a CBT therapist to start seeing in addition to him or her. This has made all the difference in the world for me. If you live anywhere near NYC -- I'd like to give my pdoc a plug -- I highly recommend Dr. Michael R. Liebowitz. The therapist that works with him, Carla Daichman, is amazing as well. They communicate and work together to provide me with the best care available. Wherever you live, don't be afraid to travel to get good care.
My advice as far as medication is concerned is find yourself one of the best pdocs and follow their advice. I use to change my meds and dosage on my own, add this, stop that, etc. As far as Paxil goes 20mg is a low dose and 3.5 weeks is not a long time at all. It really doese take time. SSRIs can take six weeks or even twelve to exert their full effect. I know when it comes to treating social phobia, for example, this is particularly true of Paxil. I recall an abstract on PubMed that said a significant amount of patients taking Paxil for social phobia were non-responders at six weeks but became responders after twelve weeks. Paxil may not be the drug for you, but give it a chance at a reasonable dose (as long as it's tolerable, of course). Otherwise, you will have wasted the last 3.5 weeks. The best advice I can give you is get a good psychopharmacologist and combine that person's expert skills in pharmacology with a skilled therapist. CBT + medication is a very potent combination, and it saves lives. Since you haven't gotten better, it makes sense to take a more robust approach. If for no ther reason, just for the hell of it. This is the path I have taken and I am the best I have ever been and my improvement has yet to reach a plateau. To answer your question, WILL THIS GET BETTER? I think it's safe to say you'll be able to enjoy happiness and function in ways you can't right now. You may always be a little more sensitive or anxious than other people, but with the help of the right doctors there's no reason to think you won't find happiness and be able to enjoy life and all it has to offer. And it may be sooner than you think! Hang in there. It's a long road... but it's worth it in the end.
Good Luck,
Jon
Posted by oracle on November 11, 2002, at 15:51:10
In reply to Please, please help, posted by cab on November 10, 2002, at 17:34:37
> I'm feeling incredibly horrible, with extreme agitation, feeling of terror constantly, extreme hopelessness, etc. I have a couple of questions -- 1) I've been on Paxil 20 mg for 3.5 weeks (after slowly moving up from 5 mg), and it wasn't helping my depression at all (which wasn't this bad until a couple of days ago). My pdoc now wants to try another 4 weeks with a higher dosage (up to 40 mg if I can handle it). Has anyone had an experience of not responding at all to a regular dose of paxil or another SSRI and then responding well to a higher dose?
Given that most do not start responding to ADs for 6 to 8 weeks, you should not be expecting much at this point except side effects.
Posted by cab on November 12, 2002, at 11:20:39
In reply to Re: Please, please help, posted by oracle on November 11, 2002, at 15:51:10
This is the end of the thread.
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