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Author Topic: 4 months on cipralex and still anxious! scared med resistant  (Read 230 times)

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Offline carly

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4 months on cipralex and still anxious! scared med resistant
« on: August 29, 2014, 10:18:56 AM »
Hi there. A little background on my situation! I have been suffering off and on with anxiety and obsessive thoughts,  as well as ddepression for over 25 years. I had always come through them with self help techniques until I was in my 30 ' s.  A few years after my first son was born, I developed hypochondria and was convinced that I had multiple sclerosis,  or some cancer. I was constantly searching the net to find that my symptoms were possible ms symptoms. After many tests and an mri,  I was still not convinced. I then decided to go on an antidepressant because I couldn't be a good mother to my son and he deserved better. I was very scared and apprehensive,  but I did it. I was so proud of myself for doing something  that for so many years scared me, that I felt relief very quickly. I was on 20mg and remained there for 8 years without issues. I was so happy to have my celexa!! Then last year out of the blue, I had a massive panic attack while driving to our holiday at the lake.  This took me by complete surprise, as I had been anxiety free ( and cured in my mind) This started my downward spiral into panic and depression.  I had no idea that a medication could stop working g. I was placed on sertraline and my condition grew worse and after 6 weeks I had to switch. I was then put on effexor xr and still had anxiety. I was up to 187.5 of effexor and after being on that dose for 2 months, I began to level off, but still not perfect. I had read so many horrific stories about the withdrawls of effexor, that it was always weighing on my mind. I saw a psychiatrist last Feb to discuss my meds and asked him if cipralex (lexapro) would be a good choice seeing as celexa was so effective and we agreed to titrate on to cipralex. So here I am now, on cipralex for almost 5 months and my dose was at 30mg,  which is high and still having alot of breakthrough anxiety. I lowered my dose to 20 on Monday because I have absolutely no interest in the intimacy dept.  I am absolutely terrified that my body will mo longer respond to an antidepressant and that I have built a resistance to them.  Sorry this is a long story, but I thought a background would help.  My psychiatrist said that he wouldn't even bother to try a different ssri and he would put me back on effexor. I did feel better on effexor but it took a very long time which makes me wonder if it was just me doing the work and not the med? Anyway I could really use some words of encouragement.  Has anyone been through the same thing? ? I just can't stop obsessing over this! !!! Thanks all for taking the time to read this!!!
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Offline insights

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #1 on: August 29, 2014, 05:54:21 PM »
So here I am now, on cipralex for almost 5 months and my dose was at 30mg,  which is high and still having alot of breakthrough anxiety.

Cipralex (escitalopram) and Celexa (citalopram) contain the same active chemical. Celexa also contain a mostly inactive form of it. So if Celexa pooped-out then it is very unlikely that Cipralex will work.

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My psychiatrist said that he wouldn't even bother to try a different ssri and he would put me back on effexor.

Effexor (venlafaxine) has such a weak norepinephrine (NE), aka noradrenaline, reuptake inhibitor that it should probably be reclassified as a SSRI. Its metabolite Pristiq (desvenlafaxine) is a little better in that regard, but Cymbalta (duloxetine) is the only SNRI to have a strongish NE affect. Unfortunately, they all have very short half-lives which can make discontinuing them tricky, though Effexor is the worst.

I think you should also consider the older tricyclic antidepressants (TCA). They fell out of favour not because the SSRIs were more effective, but because the TCAs tend to have more ongoing side-effects such as dry-mouth and constipation, and because they are less safe in overdose than the SSRI s except Celexa and Cipralex/Lexapro. The TCA with the lowest side-effects profile is desipramine (Norpramin). It is also a very potent NE inhibitor, several orders of magnitude more so than the SNRIs.

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 carly

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #2 on: August 29, 2014, 07:53:49 PM »
Thank you Ian! I appreciate your response.  In the back of my mind, I did worry that the cipralex wouldn't work being that it is similar to celexa but I wanted to at least try. My trial with Zoloft was actually the generic version sertraline and that didn't go well. I had been switched to the generic version of celexa once without my knowledge and I noticed a difference very quickly so i must not be able to tolerate the generics? Can anxiety become refractory?  Is it possible that I've become resistant to meds?  This is my worst fear. I would certainly try a try cyclic if need be. Which is the safest and best one for anxiety ocd and depression?  My doctor is pretty adamant about re trying effexor. I just really want to feel some consistency in my mental health again and I'm scared that I won't! !!
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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #3 on: August 30, 2014, 02:20:03 AM »
so i must not be able to tolerate the generics?

Most generics are as effective as the brand, though a number of studies have found that on average the brands work about 14% better than the generics, not because of what is in the box, but what is printed on it, i.e. because of the placebo effect.

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Can anxiety become refractory?  Is it possible that I've become resistant to meds? This is my worst fear.


Some people are treatment resistant, and some stop responding to their antidepressant, but there are lots of antidepressants so there is bound to be at least one which will work. And if it doesn't, there is a high probability that therapy will.

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I would certainly try a try cyclic if need be. Which is the safest and best one for anxiety ocd and depression?
 

No antidepressant is intrinsically better than another, either generally or for a specific disorder, however, one or two may be more effective than the rest for an individual. The hard part is finding it/them.

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My doctor is pretty adamant about re trying effexor.

This is your decision, and yours alone. Remember you're paying him/her, either directly, or via insurance, so you get to call the shots. It may well work, but given it wasn't a roaring success before I wouldn't bet on it. Effexor is one of the two best antidepressants for pulling folk out of really deep, dark, almost catatonic depressions and, IMHO, it is best reserved for that role. For anxiety is has no real advantage over the SSRIs, and a few disadvantages, particularly the difficulty in quitting.

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I just really want to feel some consistency in my mental health again and I'm scared that I won't! !!

There are no hopeless cases, Carly, only people who give up hope.

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 carly

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #4 on: August 30, 2014, 08:31:40 AM »
Thank you once again. Question, when people talk about the horrors of effexor withdrawls,  it is when they are stopping ad's all together. Usually when you wean on to a different ad, you can avoid some of the nasty ones yes? I had the brain zaps and so forth but they were manageable.  It's the return of anxiety and racing thoughts that I can't stand. So if I did choose effexor, and go on a different ad after it loses effectiveness,  would I avoid the horror stories?
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Offline insights

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #5 on: August 30, 2014, 08:46:42 AM »
So if I did choose effexor, and go on a different ad after it loses effectiveness,  would I avoid the horror stories?

It depends on what med your switch to. Generally, you can't do an overnight switch to another antidepressant from Effexor, except to Pristiq (desvenlafaxine) or Cymbalta (duloxetine). Most doctors would go for a cross taper if switching to a SSRI or TCA and this may produce some withdrawal symptoms.

BTW-did Effexor lose effectiveness, or was it never that effective to begin with?

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 carly

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #6 on: August 30, 2014, 09:50:59 AM »
Well, effexor was helping at 187.5 mg but I was still having the odd breakthrough but no panic attacks. I started it in Sept and worked up to that dose by December.  It wasn't until Feb that I was feeling more consistent.  By Feb I finally had my psych appointment and discussed my concerns about effexor and asked him about cipralex.  I was feeling better when I saw him but I couldn't get the worry of effexor withdrawls out of my mind. He gave me the option of increasing to 225mg of effexor or taper to cipralex.  I decided to taper in hopes that it would be like celexa was for me. I tapered very slowly and felt ok until I was down to 75 mg,  and started to wake anxious and racy thoughts, so I started the cipralex that night and continued the effexor in the morning. I felt better until I dropped the effexor all together. I did have some withdrawls but the physical stuff doesn't bother me, it was the Extreme panic and mood swi gs that really got to me. I titrated up to 10mg of cipralex,  then 15, then 20 and I was still having periods of high anxiety. After being on 20mg for a couple weeks with no change,  he upped to 30. I did have several days of feeling well and then it would hit for several days. This has gone on since April.  I had cut down to 20 on Monday this past week, and have been feeling high anxiety since. I'm so confused and discouraged.  I don't know what to do??? Advise? Have you ever had to deal with this med fiasco? ??
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Offline Never-Quit

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #7 on: August 30, 2014, 10:01:32 AM »
1.  I have been suffering off and on with anxiety and obsessive thoughts,  as well as ddepression for over 25 years. I had always come through them with self help techniques until I was in my 30 ' s.

2.  I was on 20mg and remained there for 8 years without issues. I was so happy to have my celexa!! Then last year out of the blue, I had a massive panic attack while driving to our holiday at the lake.  This took me by complete surprise, as I had been anxiety free ( and cured in my mind) This started my downward spiral into panic and depression.  I had no idea that a medication could stop working

3. I was placed on sertraline and my condition grew worse and after 6 weeks I had to switch.

4.  I was then put on effexor xr and still had anxiety. I was up to 187.5 of effexor and after being on that dose for 2 months, I began to level off, but still not perfect. I had read so many horrific stories about the withdrawls of effexor, that it was always weighing on my mind.

5.  I saw a psychiatrist last Feb to discuss my meds and asked him if cipralex (lexapro) would be a good choice seeing as celexa was so effective and we agreed to titrate on to cipralex. So here I am now, on cipralex for almost 5 months and my dose was at 30mg,  which is high and still having alot of breakthrough anxiety.

6.  I lowered my dose to 20 on Monday because I have absolutely no interest in the intimacy dept.

7.  My psychiatrist said that he wouldn't even bother to try a different ssri and he would put me back on effexor. I did feel better on effexor but it took a very long time which makes me wonder if it was just me doing the work and not the med? !

Hi Carly,

Just wanted to share my first-hand experience of over 20+ years - trying to find the best AD - only to find that as Ian mentioned - You will have to find the one the works for you, which is the hard part.  The first several SSRIs, I had tried back in early 90's was Paxil, Prozac, and Celexa.  Paxil after a couple of months - completely killed my sexual drive.  Prozac worked well but, I wanted to try something that would help my anxiety better without killing my sex drive and no problem weaning off of it - as I did with Paxil or Effexor. Celexa worked very well, but it just stopped working after about a year  ::).  After trying several more ADs -

I finally returned Prozac as the best one, that my body responded well to.  I am currently on 40 mg. - covers panic disorder 100%, (@20mg) OCD w/Intrusive thoughts: 100% (at 40 mg) - General Anxiety (80%).  Panic attacks was my main concern and OCD Intrusive Thoughts my second concern.  Anxiety was controlled about 80% (but, I could work on mental strategies for 20%) - and the sexual side effects were - not as bad as Paxil or Zoloft for me.  My doctor finally prescribed my small dose of BDZ (Klonopin, later Diazepam 10 mg) at night to cover the 20% Anxiety - that Prozac did not cover.

1.  You have Anxiety, OCD w/Intrusive thoughts, and Depression - I had Panic Disorder, GAD, and OCD w/Intrusive thoughts.

2.  You were on Celexa for Celexa for 8 years but then it stopped be effective - I had the same issue with Celexa after about 1 year, I found Celexa to easiest and fastest SSRI - but for some people, it stops working.

3.  Zoloft - again, it depends on how your body responds, is a much more potent SSRI than Celexa and after a couple of months, it tended to make me very lethargic and had more sexual side effects than Prozac.

4.  Effexor - was about 2 months - It just didn't agree with me.  Main side effects:  Was constant irritability - I would just get angry and upset on this medication when I was on it, it didn't agree with my wife and the other issue was - if I missed 1 day of Effexor - I felt the withdrawal effects right away - unlike Prozac - where I missed as many as 3 days (on vacation) with no withdrawal problems.

5.  Lexapro - Again, like Celexa, was a little stronger... but I could feel the results start to diminish over time, and it didn't cover my OCD w/Intrusive thoughts as well as Prozac.

6.  Yes... Lexapro as well the other SSRI will start kill my sex drive as I increase the dose  ::)

7.  This is where you might want to look at alternatives - It sounds as if Effexor - had mixed results for you.  I do agree that research is showing in the long run this AD along with Paxil - are becoming the most difficult to discontinue (theory- of short half life of AD).

20+ years later, after trying others like Cymbalta, Remeron, Wellbutrin, Luvox, Serzone (now discontinued), - I have come back to Prozac as the best SSRI for me, after many years of experimenting.   And use a small dose of a long half-life BZD 1x daily at bedtime.

Just wanted to share my experience with you - you may want to look at Prozac - since we both did well on Celexa...  And Prozac would be the easiest SSRI to discontinue vs. Effexor or Paxil.

Again, this is where all the fun  ::)  - of trying to find what medication will work best for you!

Let us know how you progress...

 :action-smiley-065:
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Offline carly

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #8 on: August 30, 2014, 11:36:36 AM »
Thank you so much! Did you ever feel like you were never going to feel better? I'm so scared that I'm not going to get this under some control. I have a husband and 2 boys who need their mom to be functional.  I mean I am functional,  but the fear of not having an effective med is weighing on me daily and takes up a lot of my mental space. My ocd about researching meds has got the best of me.
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Offline Never-Quit

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #9 on: August 30, 2014, 03:45:36 PM »
Your Anxiety is unfounded - we have so many wonderful tools and medications - compared to 1979- when I started my journey.

You have already found great success with Celexa - which already tells me that your body does indeed respond to medication :yes:

Now we just need to find the right combination for you at your current stage of life. 

I personally found out that for me - an AD was not enough to bring everything under control - my anxiety was not fully resolved with Prozac (which worked best for me ...after much trail and error ) but ATTITUDE made all the difference.
 
Life is too short - I have a very aggressive attitude regarding medication...

Many people are afraid of medication.  Especially when they goggle it....   All I seem to read are horror stories....  I rarely hear success stories.  It is like the News - Bad news sells and is reported 100x more than good news... 

Many of us Now know not to place too much stock in such stories on the internet .....

You just need to find another AD and fine tune-it... persistence and patience is all you need to find your next "Celexa" ....

Don't hesitate to ask and seek other people's experience - we have a supper group of understanding members here that are very caring....

You will succeed!!!
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Never, never, never give up. -Winston Churchill

“You can’t live a perfect day without doing something for someone who will never be able to repay you."   ~ John Wooden

Offline carly

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #10 on: August 30, 2014, 10:16:31 PM »
Thank you so much! I can feel the care and compassion and I really need that right now. I just hope I will eventually be able to help others here too. I'm grateful that I have people that can help and relate. I'm sure I will find alot of help here!
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Offline bluerose

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Re: 4 months on cipralex and still anxious! scared med resistant
« Reply #11 on: August 31, 2014, 05:08:24 AM »
I had an antidepressant stop working on me -- it was Nardil which is an MAOI.  I believe they're the oldest class of antidepressants and are rarely used any more because there are many food restrictions and med restrictions while a person is on an MAOI.  If you eat "forbidden foods" or take meds that are not safe with an MAOI you can have a dangerous rise in blood pressure which can be life threatening.  That being said while the Nardil worked I felt like a new person and was really happy for the first time in my life.  For some people MAOI's are the only antidepressants that work.  Just something to keep in mind if all else fails.  Also there is one tricyclic antidepressant that works on depression as well as obsessive compulsive disorder  -- it's called Anafranil.  I know what panic type anxiety feels like.  Quite a few years ago I was taking an antipsychotic for severe anxiety and to help with sleep (along with an antidepressant and other anxiety meds) and the antipsychotic (Risperdal) quit working out of the blue.  It had worked for years.  My friend said to me you're doing worse right now than when your husband died.  I was really scared because I'd been stable for so long.  I went on a different antipsychotic and thankfully that stopped the anxiety.  Some of us need to take more than just one medicine and having a therapist can also help.
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