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Author Topic: Lexapro, Abilify, Xanax...oh my!  (Read 305 times)

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Offline PlainJayne

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Lexapro, Abilify, Xanax...oh my!
« on: February 16, 2014, 02:29:24 PM »
I am new to the forums, but old hand at the anxiety game, unfortunately.  I have been dealing with GAD, panic attacks and agoraphobia on and off for over 20 years.  Some of the things I have read here have touched me and made me feel a little less alone in this struggle.  I am very grateful for that.
I seem to go through periods of severe anxiety and depression.  I have been in therapy on and off for well over 20 years - sometimes I feel like it helps and other times, not so much. 
I suffered a pretty bad panic attack last week (had been experiencing anxiety for past month or so).  It lasted for over an hour and I took Klonopin - as prescribed - and eventually fell asleep.  I try the deep breathing techniques, the positive self-talk, but sometimes it just doesn't get through in that moment.  I do not like medication (have been on Lexapro 20mgs for 3 years), but have used Klonopin PRN, usually at night as it makes me too groggy during the day.  I have little faith in it and, after this last attack, found it useless.
I have had a support system in place for the past several years - therapist, pdoc, etc.  Feel like I have tried the breathing techniques, CBT - with no relief.  What am I doing wrong?!?  Saw the therapist this week - I seem to be hung up on what triggers these events and her theory is that the trigger isn't important - as I do understand sometimes there isn't a trigger.  I feel if I understand the trigger, then I can deal with it.  Needless to say, it was not a helpful session.  Have literally been anxious all week - ebbing and flowing - struggling to get to work in the morning.  Usually once there, I begin to feel better, but that hasn't been the case this week and the week ended feeling worse than ever.  Avoiding going other places.
I called pdoc - she was on vacation, so I spoke with someone else, who feels this is somehow hormonally related/triggered.  She decreased Lexapro to 10mg, added Abilify 2mg and changed me to Xanax PRN.  As most with anxiety, am petrified to change or try new meds and certainly don't want to become addicted to Xanax.  So desperate for some relief, I tried Xanax yesterday and was cautiously optimistic - felt better than I had all week, but am still afraid the panic will break through.  Actually started the Abilify this morning - spent the day in bed mostly, just paralyzed with fear about the fear.
A few questions, when going through several days of continuous anxiety, is it normal to have to try to "break" the cycle before feeling better?  Is the anxiety feeding off itself and just creating more anxiety?  Does that constant adrenalin surge have to be calmed before I feel better?  Will the Xanax help with this? Does anyone else go through days and days of anxiety - feeling like you want to run or just crawl out of your skin?  I can't remember this never-ending anxiety, but I'm sure it's been there before - just having a hard time focusing right now.
Also, anyone have any good experiences with Abilify?  Please, no negative experiences...can't cope with that right now.   :(
So sorry to dump this - but really need something to hang on to right now...please give me some hope.
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Offline johnathonm

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Re: Lexapro, Abilify, Xanax...oh my!
« Reply #1 on: February 16, 2014, 03:12:35 PM »
I have been on Abilify for several years with no real side effects.  The drug is very good and can really help a lot.  I also have a very close friend on it who has had similar results.
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Offline insights

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Re: Lexapro, Abilify, Xanax...oh my!
« Reply #2 on: February 16, 2014, 04:34:07 PM »
I do not like medication (have been on Lexapro 20mgs for 3 years),

If your on the maximum dose of an antidepressant and are still having anxiety attacks then you need to try something else. Have you been on other antidepressants previously?

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but have used Klonopin PRN, usually at night as it makes me too groggy during the day.  I have little faith in it and, after this last attack, found it useless.

If Klonopin isn't working then the dose is probably inadequate.

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As most with anxiety, am petrified to change or try new meds and certainly don't want to become addicted to Xanax.

You're already probably dependent on Klonopin, so what's the difference?

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Saw the therapist this week - I seem to be hung up on what triggers these events and her theory is that the trigger isn't important

She's right. It is how you handle the anxiety once it's triggered which matters.

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A few questions, when going through several days of continuous anxiety, is it normal to have to try to "break" the cycle before feeling better?  Is the anxiety feeding off itself and just creating more anxiety?

Yes to both. You need to get on top of the anxiety. Hopefully, the new med regime may do that, though I consider it only a temporary measure. IMHO, an effective antidepressant should be the treatment cornerstone. Clearly Lexapro isn't working so it should be replaced, either by another SSRI, or if others haven't been successful in the past, with a SNRI (not Effexor (venlafaxine)) or one of the tricyclic antidepressant.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline PlainJayne

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Re: Lexapro, Abilify, Xanax...oh my!
« Reply #3 on: February 17, 2014, 05:18:46 PM »
Ian,
The max dose for Lexapro is 30mg - not 20mg - so I am not currently on the max dose.
Many meds do not work for everyone - if that was the case, then there would be one antidepressant, one benzo, etc.  Klonopin wasn't for me.  Maybe you missed in the post that I took it PRN - AS NEEDED - so I take great offense to your comment that " You're already probably dependent on Klonopin, so what's the difference?"   I use any benzo very cautiously and sparingly.   I don't appreciate your rude, insensitive and inaccurate comments.  That isn't why I joined this forum.  I joined for support and advice - and believe me, I am willing to be open to things I may not want to hear, however, your response regarding Klonopin was downright offensive. 
I hope you when you try to offer others "support", you think twice about how you phrase things.


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Offline 2sungo

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Re: Lexapro, Abilify, Xanax...oh my!
« Reply #4 on: February 17, 2014, 07:16:50 PM »
Ian was not trying to offend you, just offer his best advice.  He's spent a lot of time helping many folks on this forum. AFAIK 20 mg is the max for Lexapro in most cases these days in the US due to concerns about QT heart stuff, I am sure one can go higher and before this was known about its cousin Celexa it was often done without problems.  But to be on the super safe side most pdocs that I have come across leave it at 20 mg max.  As for the benzo questions, if you are asking about Xanax and worrying about clonazepam you really are talking about the same thing in essence.  Xanax is quicker acting but in my personal experience I found it to be problematic b/c the quick rebound was not fun.  Clonazepam has a longer half life, so the rebounds are often not as bad, yes if you take it regularly you can become dependent, as I am right now but even an AD can have distressing side effects if suddenly stopped.  I take 1mg daily, half at night and a quarter each when I wake up and at 4, and perhaps a another eighth on the rare really bad day.  I've tapered off clonazepam in the past without issues (went slowly of course) and would do so again if I can get my AD to work fully or if I try another one that works better (current one is not doing 100% like it used to).  We are all afraid of the medicines for anxiety, its part of the condition actually.  And the one thing that I don't worry about is the safety of clonazepam, I don't drink so that's not a problem, and  I have a cousin who has taken 1.5 mg for decades (she has had both seizures and panic disorder) and never had to increase it.  I'm not saying you have to do this, we are all different metabolically, maybe Abilify will be your ticket.   As for triggers, those aren't really the issue either, the answer is getting control of the anxiety, I believe this stuff is in the genes and although stressors can bring it out/worsen it its counterproductive to seek triggers if knowing that won't fix the problem.  Its not a problem that lends itself to logical fixing if so I would have had it conquered from day 1.  If you had success before in dealing with it, you will again, it just might be a different route to get there.  You certainly didn't do anything "wrong" to make it happen.  Sometimes it just happens and then its time to figure a way out of it with the help of your therapist and a good doc.  Best of luck, hope you feel better soon.
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Offline insights

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Re: Lexapro, Abilify, Xanax...oh my!
« Reply #5 on: February 17, 2014, 10:29:56 PM »
The max dose for Lexapro is 30mg - not 20mg - so I am not currently on the max dose.

Yes, you are. It used to be 30mg, but this was revised down to 20mg a couple of years ago when it was found that Lexapro and Celexa could affect the electrical system of the heart at higher doses increasing the risk of inducing QT interval prolongation (see also: FDA Celexa advisory).

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I may not want to hear, however, your response regarding Klonopin was downright offensive.

Just because you are taking Klonopin PNR doesn't necessarily mean you aren't dependent on it. It all depends on how often you take it. Because of its long half-life you do not necessarily need to take it daily to become so.

My question was an attempt to understand why you were comfortable taking Klonopin, but concerned about "addiction" with Xanax. BTW-benzodiazepines do not cause addiction. There is a difference between addiction and dependence. This study concerning a popular over-the-counter painkiller should explain what it is: Hirschowitz BI, 1998. Those dependent on benzodiazepines do not normally act the way the majority of the 30 patients in this study did.

What do you find so offensive about dependence? Many medications cause it. You are almost certainly dependent on Lexapro, for example.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

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