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Offline poppadr3w

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Paroxetine Questions
« on: February 28, 2014, 10:54:58 PM »
Hey all,

I went to my General Physician today since my anxiety has been worsening. Since late 2012 I've been having issues. In early 2013 the issues disappeared, but reappeared in June/July of 2013. Then it kind of decreased but was present slightly, and  then it came back a few weeks ago with a vengeance after my grandmother passing away a few weeks ago.

Since the initial incident in 2012 (My first every anxiety attack), I've seen an array of specialists, most notably a Cardiologist and Gastroenterologist. Both ran a ton of tests, all came back pretty clear. Gastro ran an endoscopy and found a MILD hiatal hernia, which she said was nothing to worry about and that she didn't even want to tell me that I had it since most people do, in fact, have them.

I went to a Psychiatrist. He initially put me on Adderall and Xanax (I was having anxiety and concentration issues). The Adderall created an anxiety attack about a week in (The concentration was AWESOME though. I felt... alive!), so I stopped it. I then tried Lexapro from my GP which gave me impotence (I know, awesome, right?!) and deep depression. I then stopped for awhile since I felt ok.

After awhile I went back to the Psychiatrist for feeling unwell. He put me on Cymbalta, which was... meh. Anxiety was ok, but I felt out of touch with reality. He upped it to 60mg from 30mg eventually, which lasted all of three days. Then severe anxiety attacks came. So I stopped.

Then I tried a "holistic" route, taking supplements such as St. John's Wort and Valerian Root. It helped a bit, but my anxiety overpowered it, so I stopped.

Now I am to start Paroxetine tomorrow (12.5 mg, 1x/day). I got go my Psychiatrist on March 17th (The earliest appointment I could make), but I needed something in between.

I read that it can cause weight gain. This scares me... A lot. I care about my body and my weight. I've worked very hard to gain muscle and become more lean, and I think that gaining weight would crush my self esteem. How bad is the weight gain? Is it due to a slow down of the metabolism or due to an increase in appetite or both?

Yes, I do know that side effects vary from person to person, but I try to see what are the most "popular" side effects per medicine. Impotence will kill me as well.

Can it cause fatigue? The Xanax is absolutely draining me. I nap every day, sometimes even twice per day. I'll be sitting at my desk at work and just put my head down at times because I get so drained and tired, even in the morning. I tried taking a Vitamin B Complex, but it hasn't done much thus far.

Thanks in advance for all that reply!
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Re: Paroxetine Questions
« Reply #1 on: February 28, 2014, 11:59:14 PM »
The Adderall created an anxiety attack about a week in

Hardly a surprise. It is a powerful stimulant which would drive most with anxiety disorders up the wall.

Quote
Now I am to start Paroxetine tomorrow (12.5 mg, 1x/day). I got go my Psychiatrist on March 17th (The earliest appointment I could make), but I needed something in between.

I read that it can cause weight gain.

Paxil may do, but it can also cause weight loss. It all depends on your individual biology.

Quote
Is it due to a slow down of the metabolism or due to an increase in appetite or both?

Probably a combination of both.

Quote
Impotence will kill me as well.

Unfortunately, most antidepressant will cause sexual dysfunction to some degree. There are things you can take to reduce this.

The antidepressants that don't usually affect the libido are Wellbutrin (bupropion),  Remeron (mirtazipine) and Desyrel (trazodone). 

 - Wellbutrin is the most stimulating of the antidepressants, often too stimulating for those with anxiety disorders though a few do well on it.

 - Remeron is a sedating antidepressant which can trigger powerful carbohydrate cravings than can have people literally eating sugar straight out of the bag. Many balloon in weight when taking it. It is also the antidepressant most likely to stop working.

 - Desyrel is another sedating antidepressant which these days is mostly prescribed in small doses to counter SSRI induced insomnia. It is a biphasic drug that only acts as a antihistamine, hence the sedation. At higher doses, 150-225mg plus, is begins to act as an antidepressant and becomes less sedating. It is a pretty good antidepressant if you can get past the initial sedation hurdle, usually quite effective and with fewer side-effects than other antidepressants. Instead of diminishing the libido it often enhances it.

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Can it cause fatigue?

The SSRI most often cause insomnia, though as with everything about antidepressants, your mileage may vary.

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The Xanax is absolutely draining me

All the benzodiazepines are initially sedating, but this tends to wear off quickly, usually within a couple of weeks.

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.

Online DeLellis123

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Re: Paroxetine Questions
« Reply #2 on: March 01, 2014, 12:06:56 AM »
I actually lost weight and had a hard time getting it back on, mind you I was on it for 3 months and on 20 mg as my highest dose. I'm still trying to put it back on. Everyone is different tho
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Offline poppadr3w

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Re: Paroxetine Questions
« Reply #3 on: March 01, 2014, 01:38:21 PM »
Thank you both for the kind replies.

I took my first dose this morning, but, obviously, it's too soon to tell if it'll do anything. No Xanax yet as of this time, though! My stomach is still bothering me, but it feels more muscular than anything. I think the anxiety has been causing some abdominal tightness in my stomach region.

I've been taking the Xanax for awhile, but not consistently -- except as of lately (Within the past 3-4 weeks).

The Cymbalta didn't do anything to my libido, but the Lexapro did. If I have any problems arise within the next couple of weeks until my Psychiatrist appointment, then I'll tell him about it and see what he wants to do. He's very good at what he does. I saw years and years ago when I was in my teenage years and stopped abruptly (I was on Prozac) -- Bad idea, I guess. When you're younger you feel invincible, so you don't really take into account how powerful these drugs can be, especially when coming off.

I'll watch my weight as much as possible. I really try not to go by the scale -- a rule I've had since becoming a Certified Fitness Trainer. I go by how I feel and look aesthetically. If I want to measure anything, I'll go by the tape, not by the scale.

I think my other Psychiatrist (The one that put me on Adderall, Xanax and later Cymbalta) was quite incompetent. He was an older man (Very old) that seemed, to me, kind of out of it. He never gave straight forward answers (I ask a lot of questions!) when I talked to him. He always spoke in metaphors and analogies. It really put me off, since I like to hear scientific reasoning for why a medicine will work (In regular terms that I'd understand, of course). I felt like he was throwing medicine at me... I thought the two were two extreme (Adderall & Xanax), but the way he worded it made some sense and, well... He's the professional! Right?!

When the Cymbalta started to cause issues, he increased it. I spoke about this in my first post, I believe. When upped to 60mg, it was like a train of anxiety. I get anxious about taking any medicine, even Xanax at times, but it'll generally subside. With the increase in Cymbalta it didn't. Just laying down watching a movie with my girlfriend I'd get chest tightness and start to sweat. Great, right? When I called him after a few days I seemed like a BOTHER to him. I spoke with the secretary first, and she forwarded me to him on the phone. It was like I was taking too much of his time for feeling terrible. That's when I stopped going to him and started going the holistic route at a wellness center that I go to. That seemed to do well, but... I don't think it was powerful enough. I'm not a total loss -- I can function pretty well and see certain people. I can leave the house and go to work. But I feel like I am living at 25% in life. I feel like I have potential hidden away in my body that cannot be reached until my anxiety is remedied.

And now here I am...

Sorry for rambling a bit.

If there is any more words of advice, I'd appreciate it. I'll continue to exercise 5-6 days a week to keep the weight off or minimize the weight gain, if there is any. I know that it varies from person to person. Some people lose it, others gain. I feel like the ones that gain it overshadow the ones that lose it since they are more vocal when it comes to online forums and such.

:)
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Offline CrazyCatLady

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Re: Paroxetine Questions
« Reply #4 on: March 01, 2014, 02:03:30 PM »
I thought I'd chime in about the weight gain thing. When my anxiety started up, I completely lost my appetite and it didn't come back until a few weeks into starting SNRI's. Therefore, I lost weight during that time period. Once the medication had a chance to kick in, my appetite came back and I'm now at my initial weight. I haven't gained any additional weight, but I have noticed a slight increase in appetite. But since I track what I eat, I think I'll be able to ride those cravings out  :yes:

Good luck!
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Offline poppadr3w

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Re: Paroxetine Questions
« Reply #5 on: March 01, 2014, 02:37:33 PM »
I thought I'd chime in about the weight gain thing. When my anxiety started up, I completely lost my appetite and it didn't come back until a few weeks into starting SNRI's. Therefore, I lost weight during that time period. Once the medication had a chance to kick in, my appetite came back and I'm now at my initial weight. I haven't gained any additional weight, but I have noticed a slight increase in appetite. But since I track what I eat, I think I'll be able to ride those cravings out  :yes:

Good luck!

Thanks for the input (P.S. I love the username!)

I've lost weight initially, but that was due to my diet. Now I am going through an intentional caloric surplus cycle to gain some muscle. I just want to ensure that I don't start gaining a ton of fat because of the medication. My cravings are normal, but sometimes I have a hard time eating because of gastrointestinal distress associated with the anxiety. It feels as if I am full already, like stuffed to the brim, but I haven't eaten anything. I get pressure in my chest and my stomach knots up and it gets harder to breathe. I've gotten used to the fact that it happens, but when it does... It's still very unpleasant.

I'll try monitoring what I eat a bit closer and watching fluctuations in body fat %.
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Re: Paroxetine Questions
« Reply #6 on: March 01, 2014, 04:17:10 PM »
When upped to 60mg, it was like a train of anxiety. I get anxious about taking any medicine, even Xanax at times, but it'll generally subside. With the increase in Cymbalta it didn't. Just laying down watching a movie with my girlfriend I'd get chest tightness and start to sweat. Great, right?

Unfortunately, antidepressants often increase anxiety, both when first taking them and also after each dose increase. It's caused by the increase in serotonin activity. The brain responds to this by reducing serotonin synthesis and expression and the added anxiety usually diminishes within a couple of weeks as do the other side-effects.

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 poppadr3w

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Re: Paroxetine Questions
« Reply #7 on: March 02, 2014, 11:36:43 PM »
When upped to 60mg, it was like a train of anxiety. I get anxious about taking any medicine, even Xanax at times, but it'll generally subside. With the increase in Cymbalta it didn't. Just laying down watching a movie with my girlfriend I'd get chest tightness and start to sweat. Great, right?

Unfortunately, antidepressants often increase anxiety, both when first taking them and also after each dose increase. It's caused by the increase in serotonin activity. The brain responds to this by reducing serotonin synthesis and expression and the added anxiety usually diminishes within a couple of weeks as do the other side-effects.

Ian

How long does this initial side effect generally last? A week? I've felt pretty bad all day. I feel out of it moreso than usual and have had more anxiety attacks. Even in the gym -- the place where I never felt one -- I've been getting them. I have a gym at home, so I can just lay on the bench for a minute or two to relax, then proceed again, and so on and so forth. But still. Today my chest tightened up so bad I laid there a bunch of times. Eventually I got fed up and said "F*** it" and pushed through the sensations.

Today was only my second time taking my Paroxetine (12.5mg).

Whenever I get an anxiety attack that is so bad I cannot take it, I take .25mg of Alprazolam (Xanax). I don't want to get a dependency on it, but I *NEED* it at this point. I wait until it gets really bad and until the Paroxetine can take effect. I'll see what my new Psychiatrist says on March 17th when I see him.

Any other advice as well?
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Re: Paroxetine Questions
« Reply #8 on: March 03, 2014, 12:33:43 AM »
How long does this initial side effect generally last? A week?

It all depends on your individual biology. Many don't get much in the way of side effects, others only mild symptoms and a few have a hard time of it which can last from days to several weeks.

The thing to keep in mind always is that while the side-effects are unpleasant, and sometimes scary, they won't actually hurt you. People don't die from antidepressant side-effects, but anxiety, depression, stress can end lives prematurely through heart disease, cancer, suppression of the immune system, etc, either directly ,or by affecting the life choices people make, smoking, poor diets, lack of exercise, etc.

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But still. Today my chest tightened up so bad I laid there a bunch of times. Eventually I got fed up and said "F*** it" and pushed through the sensations.

That was exactly the right thing to do. :yes:  If you can confront anxiety and push through it when it rears up then you're more than half way to recovery.

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Whenever I get an anxiety attack that is so bad I cannot take it, I take .25mg of Alprazolam (Xanax). I don't want to get a dependency on it, but I *NEED* it at this point.

Then take it. This issue of benzodiazepines (BZDs) and dependency has been blown out of all proportion. People become just as dependent on antidepressants, but most think nothing of it. The point of medicating anxiety is not to be anxious, and if this means taking a small BZD dose then so be it.

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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