Read your post here, as well as in reply to Foxy's question about why antidepressants are recommended for anxiety.
Please know that many people have this reaction to SSRIs when they first start them. The digestive tract has more serotonin receptors than anywhere else in the body (even the brain), so many people feel nauseous when they first start them, since the receptors are dealing with more serotonin than normal.
The reason you feel anxious (tremors, insomnia, restlessness) when starting them is as follows: the theory is that those with depression (and possibly anxiety) have smaller amounts of serotonin circulating in the brain. Because of that, the brain has, over time, increased it's numbers of receptors, hoping to mop-up all available serotonin it can find.
When you start taking SSRIs, the medication increases the amount of serotonin available to the receptors. This wouldn't be so bad if you had a normal number of receptors, but if you have a huge number, your system is suddenly flooded with serotonin. In normal doses, serotonin "activates you" and makes you feel good (hence people with depression feel lethargic and inactive). In too high doses, it "over-activates" you - the symptoms you describe.
Two things to note: 1) the symptoms go away after a short while - say, a week or two after beginning the drug. This is how long it takes the number of receptors to down-regulate to a normal number. 2) the ironic thing is that people who get this reaction may be exactly the people who NEED it most, for the reasons outlined above.
It's a shame, I agree, because the side effects are miserable. Even though I'm a doctor, I'm on an SSRI, too (for anxiety), and I had the same reaction when I first started. (So, just so you know, doctors don't only prescribe these meds, we take them, too!)
My own doctor put me on a low-dose benzo for the first week, and also had the pharmacy compound down the drug so that each pill contained only a very small amount - eg. instead of starting with 10 mg of Celexa, I started with 2 mg, then increased to 4 mg, then to 6 mg, until I worked up to 20 mg. Ask your doctor to try this for you.
Unfortunately, I'm not sure you'll notice much difference in side effects between the different SSRIs. As I said, the side effects are actually a sign the drug is working, and despite the different names, they all work more-or-less the same.
The withdrawal side effects are true with regard to Paxil (though I've had patients comment on similar withdrawal from Celexa and Effexor - it may be the same for all of the SSRIs). The drug companies call it a "discontinuance syndrome" as opposed to withdrawal, but whatever you call it, it's miserable. I've missed a few pills now and again, and I know what you're talking about.
I'm suspicious that more than one doctor has diagnosed you with anxiety. Also, you mention you thought you were "in control of things" - this is a classic phrase for someone with anxiety. When we're anxious, we try to stay "in control" of things, hoping this will alleviate our anxiety. In fact, people who aren't anxious don't have to concern themselves with controlling things because they can trust in their ability to handle whatever pops up.
This isn't a criticism - just a comment. Ultimately, you need to be the one to decide if you need to be on something. As I said, I suffer from anxiety, too. It isn't anything to be ashamed of, and if you do have anxiety, your life will be markedly better if it's treated - whether that's with medication, therapy, meditation, or whatever. There's a lot of bad press out on these antidepressants, but despite their side effects, they've turned a lot of people's lives around - including mine.
That's a great question because you're right - Trazodone is marketed primarily as an antidepressant. In fact, it's use as a sleep aid is "off-label" - meaning it isn't really meant to be prescribed for that, but often is.
The answer to your question - if you're on Trazodone, why do you need another antidepressant? - comes down to dosage. Trazodone hasn't done so well as an antidepressant because it is so sedating. The anti-depressant dose is normally 300 mg, whereas the "sleep-aid" dose is only 50 mg. Well, you can imagine that if 50 mg puts you to sleep, you'd have a hard time functioning on 300 mg! Because of that, Trazodone isn't used as much for depression. The dose at which it becomes an effective anti-depressant is just too sedating.
So the short answer is that the dose of Trazodone you're on (likely in the 50 mg range) probably isn't high enough to produce anti-depressive or anti-anxiety effects.
I understand your desire to "get off these meds completely," however I would encourage you to concentrate first on simply feeling better, whatever it takes. You don't say much about what brought you to the doctor in the first place, but presumably the doctor has reason to believe you'd feel better if your mood was treated.
I detect in your email the sense that you feel you SHOULDN'T need these meds. We have a tendency to think this way - what's wrong with me that I can't pull it together and just cope like everyone else? First of all, let me assure you an enormous number of people are NOT coping. Secondly, there are many, many more people taking SSRIs than you know. It's true that people tend not to talk about it - which is a shame, because it lends a certain stigma to being on an anti-depressant. That's the reason I'm so open about it. I don't judge myself for "needing" this drug anymore than I'd judge a diabetic for "needing" insulin. People are just put together differently - it's what makes us all amazing and unique!
The bottom line is this: lots of people are on these meds, including lots of successful, admirable people, and lots more people SHOULD be on them because it might make their lives a whole lot better. Having said that, I don't know your case, and it will really be up to you and your doctor to decide on whether you need treatment. Incidentally, there are several excellent new drugs out now for sleep which are not in this family of medicines, so if Trazodone isn't for you, for whatever reason, ask your doctor about them.
Most importantly, if you DO decide to start an SSRI - I strongly encourage you to speak to your doctor about calling the pharmacy and asking them to compound your medications into smaller starting doses. That way, you can go up just 1 or 2 mg at a time. You've already had a reaction once and there's no reason to go through that again. Many doctors don't know they can do this, but all it takes is a simple phone call to the pharmacist! If you're able to do this, I'm willing to bet you can give another SSRI a fair trial without these miserable start-up side effects. Then you'll really know what are your own symptoms versus what are simply side effects!
Well, its only been 3 months since that experience and my only problems had been that I was just getting bad headaches, hot flushes and nausea. Thats when I went to the dr and started with the paxil nightmare. So, I feel the anxiety symptoms were bearable before all the med's. Also, I now have accepted the symptoms were caused by anxiety, which I refused to believe prior (I swore there was something physically wrong with me.) Since I never really had any problems with anxiety before and am not depressed, I do think Im a candidate for the SSRI. I am hoping that with some therapy, exercise, Xanax (short term), the trazodone to get me sleeping again (which again was never a problem before the Paxil) and a good mental state, I will be ok. My doctor is aware of my concerns and hopefully we can work together to help me. Well, good luck to you and for those of who who are getting the proper help. I feel for you and keep you all in my prayers. Thanks again for taking the time to write. Maria
What a terrible experience.
A miscarriage is bad enough - it can be an awful loss despite how common it is. Then to have the subsequent experience you had with the anaesthetic. I can't even imagine. No wonder you developed anxiety - I would think that's a natural reaction given that you went from a pregnancy to a miscarriage, to a close brush with a permanent disability. Who wouldn't be affected profoundly by that?
Given that, perhaps it's natural that you'd feel anxious following that. Since you weren't particularly anxious before, there's every chance that the symptoms will resolve in time on their own as you come to terms with what happened to you and incorporate it into your life history. Sometimes I think we're too quick to medicate people when they're having what's probably a completely natural and healthy reaction to a terrible event. In medicine, when a symptom lasts "too long" we call this an "adjustment disorder." So for instance, it's "acceptable" to grieve the loss of a spouse for three months, but any longer might be considered "excessive." Of course, this is completely absurd - we are each different and complex beings who deserve the respect to recover by whatever means and in whatever time frame suits us best.
I'm not surprised you thought there was something physically wrong with you - many anxiety symptoms ARE physical (yours were anyway), and since you weren't prone to anxiety before, they wouldn't be symptoms you were familiar with! Your point about perhaps not being a candidate for an anti-depressant is well-taken and I'm glad your doctor is listening to you. You know your body (and mind) best! And it certainly sounds like you're taking care of them both; your plan to use therapy, exercise, a short-term benzo and some sleeping meds to recover seems very sound.
You sound like a resilient person who will likely come through this time stronger and with a better understanding of yourself. Adversity breeds compassion - not only for others but for ourselves, which is perhaps even more worthwhile. I wish you the best of luck in the days ahead, and remember - it may matter less HOW you get through this time than that you simply DO!
By the way- one thing I forgot to ask before was, "has anyone tried either trazodone or remeron as a sleep aid?" As I said earlier, I was taking trazodone, but feel like its making my anxiety worse, and know it has W.D effects whereas I dont think remeron does? Has anyone had any experience with either as a sleep aid? Thanks again. Maria
Sorry to hear you're having such a rough time. It's hard to know what to do sometimes - should you stick with the meds for a while and see if things improve, or ditch them altogether? It really does seem counter-intuitive to be taking something that makes you feel worse - nuts, really. However, as I mentioned in an earlier posting, these early side effects often don't last and - most importantly - may be a sign that there really is biochemical imbalance in the brain. It's ironic - the people who react the worst to these medications at the start may be the ones who need them the most.
Remember that the shakiness and diarrhea are signs that the drug is working to re-set your serotonin system. Within a few weeks, this could be making you feel a lot better. I get so frustrated by people who write about their experiences with a certain drug by saying, "It didn't help and in fact, made things worse," and then mention they only took it for three days. I know that's not the case with you, I just advise you to be wary of opinions based on little fact and only very little anecdotal experience.
Personally, I had horrendous experiences starting Zoloft, Effexor and finally on Celexa. I wasn't a doctor at the time I started the Zoloft and I stopped it after a few days because I was scared of how I was feeling. Again, I only took Effexor for a few days and nearly had a manic episode - I was so keyed up I didn't sleep at all for the first forty-eight hours and was having racing thoughts, shakes, etc. I was lucky to be referred to a psychiatrist willing to work with me (short-term) - I really wanted to give one of these drugs a try but couldn't see how I'd be able to stay on them long enough to see if they'd help. Through a combination of Ativan (similar to your Xanax) and a very slow taper up by just a few milligrams at a time, I was able to successfully get to a therapeutic dose of Celexa, which I've now been on for three years with excellent relief of generalized anxiety.
Having said that, I'm not sure why you're having this reaction to Trazodone, assuming that you're only taking it at the lower sleep-dose. If sleep is your main worry right now, there are several other medications which are good for sleep that are not likely to have this effect. You might consider trying something else for sleep - a tiny dose of Amitriptyline (a tricyclic antidepressant - Trazodone is not a tricyclic, by the way) can give one the sleep of the gods with no increase in anxiety. And, of course, there are a whole new family of sleep meds such as Sonata, Ambien, Lunesta. Imovane is another very effective drug - prescribed a lot in Canada since the previous three mentioned aren't yet available.
My suggestion to you would be to ask your MD to refer you to a psychiatrist. Not because you're crazy, but because they're experts on these meds. Unless, of course, you're already seeing once, but I got the sense it was your family doctor prescribing for you. There are even psychiatrists (and psychiatry clinics) specializing in anxiety, and they are very familiar with these early adverse reactions and how to manage them. In the end, it really depends on what your baseline anxiety level is like without meds - if it's interfering with your life, you probably do owe it to yourself to have a decent trial of a good anxiety med under the care of an understanding physician willing to work with you to manage the early side effects.
I was simply asking her about the trazodone and if it could cause the shakes and she told me to stop taking it and try remeron, never answering my question. I was trying to ask her, as she has beat around the bush with this question a number of times, if the trazodone was going to help eventually with my anxiety/depression. (She once said no- it was for insomnia only and then another time said it would help the depression). My point was simply since I am taking it already for two weeks, and if it can treat depression, I would stick out the shakes. (Like you said it must mean that it was working.) Well, when I told her I didnt want to switch, as I already had 2 weeks invested in it, she started yelling at me and saying if I wasnt going to listen to her advice, she would have to refer me to someone else. Pretty unprofessional- I think.
Anyway, I went back to my primary dr, as there is a month wait for a psych here in NY, and he said the 25 mg of trazo was a "baby" dose and to start taking 100 and that would in fact treat the depression also. I am pretty psyched, since you know how I reacted to one of the ssri's and if this can treat the anxiety/depression- the side effects arent too bad. Of course, being the big chicked I am, I only took 50 last night and will try the 100 tonight. (I was afraid to jump from 25 to 100, even though the dr said i would be fine.)
I think I finally am realizing it is all in your attitude though, and even though I am still shaking a little, I now realize that my constant worrying is causing it, and already feel better now that I know the worrying makes the physical stuff worse and to just stop obsessing. When I start to question, "will i become addicted to the trazo or the xanax and have bad w/d and have to stay on it, or how much longer will i have to be taking it, i now try to stop myself and say- one step at a time. i truly believe in God and know that with faith, he will help us all through this.
either way, you have been great- pls stay in touch and i hope soneday i can return the favor to you or anyone else, for that matter.
It is such a beautiful place but every day I am rittled with problems. Having trouble breathing, dizzyness, feeling faint and detached, can't breath through nose (deviated septum) , can't excersise (torn labrums in both shoulders) , feeling there is something wrong with my eyes and thinking I have a brain tumor..and of course Just missing home.
I really hate complaining about things but it got really unbearable for me. SO the doctor gave me some lexapro to try about a month ago which i refused to take until about 3 days ago. I really did not and still do not want to be on meds, but this is my last resort or I will have to drop out and go back home and face all my friends and family who I will have let down.
The 3 days I have been on this I have not been sleeping properly, I am sweating a lot and feeling very feverish and even more light headed. Numb in my arms and legs, usually in the mornings.. and usually extremely dizzy and nauseous at bed time. I am not able to study under these conditions but I was unsure whether to stop taking these pills and try to deal with the anxiety or keep taking them even though things are worse.
Point of writing : I have done hours and hours of reading online and this thread here has been the most useful. Real knowledge and explanations. Louis thank you for explaining things in ways that no doctor or form has been able to offer. It seems all they can muster up is "your anxious, take these pills" .. So while i still feel I have a lot of physical problems that get overlooked by the doctors because they chalk everything up to anxiety now.. I just wanted to say thanks to you and mariak for asking away :-D
This was a couple years ago now, I hope you both are doing very well!
I have come along way and always felt that I had dealt with my isssues at hand well throughout the years. I smoke alot of marijuana to cope with my anxiety.... but i think this is why i have problems. it helped to subside the anxiety and i never allowed myself to think about yesterdays.. I have been seeing phsyciatric help since i was nine, and after getting bumped up the line sevn times with seven different specialists, i gave up on that and persued a fresh life without seeking help.
In this last week i have been a zombie. sick to my stomach ( i stopped takiong my birth control which ive only been on for two months to ease the sickness of Paxil) I have woken up EVERY HOUR every night, even though before i goto sleep I am so wiped i feel like i may sleep forever. I have had the worste mood swings, one at my bosss over something that ID NEVER have made a stink about in the past... and now i am very discouraged and helpless to think that i am not going to feel better ever. I decided to ask about meds to get off marijuana...because that also has effected my life in a bad way, where i am in school and need my brain. But it has been the only thing since i was eleven to take away the anziety and help me eat, and not be sad and sleep well... well... this is just a vicious cycle that i am on all alone.. i am very scared and i feel as though i have just dug myself into a wet concrete hole with the sun beating down on my chance to get out... If only i could sleep, not even my pot helps me anymore....