New here but have lurked for a little while and am very impressed with the active online support I see here. Would like to ask you all your opinions on the tx I'm doing for anxiety and depression. I hope I'm posting this in the right place. And please forgive me if this is overly long.
First, some history. I'm a 48 year-old male and was first diagnosed with anxiety and panic disorder 20 years ago. I'd always been a rather intense young man, exercised a huge amount (e.g., 30-40 mile bike rides most days for a time period, eight-mile runs in the mountains most days for another period, hard manual labor jobs, etc...) since I was about 19 and that probably helped mask some symptoms, although I'd always had panic attacks in medical/doctor situations (no one ever called them panic attacks back then, though). At 28 I was in grad school, not exercising as much, had a terrible relationship in which I was a rescuer of a self-destructive woman, my grandmother died, my dad died, and that's when the whole panic thing started. Didn't get treatment until a year or two later, at which point a psych put me on Paxil. Well, the Paxil killed my sex life for the most part, but it did stop anxiety and panic (except when at the doctor's).
At 31 I got a great job overseas, was happy, ran out of Paxil a couple years later at 33 years old and was fine. I did start having anger and frustration problems, some "anger attacks" as I like to think of them, but no real anxiety, depression or anything like that. However, the job ended when I was 38, I returned to the States, got married, got a 9-5 job, and I started getting the anxiety and panic attacks again. I felt really trapped. That was the key, I think, in triggering the attacks. So at 40 years old I went back on the Paxil again, got sick of the side effects after a year and quit, and at 41 or 42 got put on the generic for Lexapro. The Lexapro helped, it didn't have nearly the side effects of Paxil, and I just sort of went on with life, reasonably content although I gained about 40 pounds, but still struggling a bit with anxiety and panic. The doc increased my dose on Lexapro from 10mg to 20mg after a couple of years (say at age 45). Also had some alprazolam (Xanax) for the occasional panic attack, and 30 0.5mg pills would last me about six months.
Then, after being on the 20mg for a year, I began to get heart palpitations (cardiologist diagnosed as PVCs and wasn't too worried about them, but they were very uncomfortable and triggered severe anxiety/panic). I would pop the Xanax as it was the only thing that would calm down the PVCs. The doc and I never figured out that it was the Lexapro causing them until this January (age 48) when the generic I'd been on was replaced with a generic from another manufacturer (Cadista Labs). Wow, whereas previously the PVC's would show up for a week or two and then go away, now the PVC's hit with a vengeance, more powerful, almost every heart beat, and it was horrible. So I stopped the escitalopram (generic Lexapro) and the PVC's started to fade after a day or two. Waited another day and they were mostly gone. So I did an experiment and took a pill. Bam, PVCs right away. Waited another day or two for them to go away, then took half a pill. Again, most PVCs.
So I went to my doc and told him what happened and that I wanted to see a psychologist to try some kind of "talk" therapy instead of meds. I really should have been doing this all along, I realize that now, but it gets so darned easy to just get along when on a med. Well, my anxiety of course increased, I used the Xanax to get by, but the counselor was really helping me in January and February. I felt great about my progress against the anxiety, the book he'd given me (Mastery of Your Anxiety and Worry, by Craske and Barlow) was helping greatly by having me keep logs of feelings, thoughts, behaviors, etc..., but three weeks ago, wham! I got hit with depression. I'd never felt anything like this except for immediately after deaths in the close family.
For no reasons that I could identify, I was overwhelmed with sadness, depression, hopelessness, and so forth. The anxiety is less, maybe because the Xanax has helped with the depression (thank God). The first week it hit I saw the counselor and he gave me some ideas for dealing with it, but I've had no progress. The only thing that helps has been a 0.5mg Xanax or two a day. For the past two weeks I was out of town, couldn't reach my doc, and I suffered mightily with the sadness and depression. Today, I got back to town and talked with my doc who wants me to start taking Cymbalta for the depression. What are your thoughts? Is it worth a try? My depression seems somehow connected to my anxiety, the fact that the Xanax helps with both seems to imply that, and the way I was using my own thoughts and the talk therapy was starting to beat the anxiety when the depression manifested also is suggestive of this. Do you think my plan to take a low dose of Cymbalta to help with the depression and continue with seeing a counselor for fighting the anxiety is the right way to go? Any further suggestions or advice?
Thank you in advance,