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What do I do? (SSRI effects)


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Down the road I'm looking at a very short course of SSRI treatment to permanently squash anxiety and to mellow down.

The problem is: I have BP, and can react strongly to SSRIs. What's more is SSRIs get into and affect the areas for memory, cognition, and behaviors (it's happened to me and my family members as well).

What do I do about this?

1) Do I:  take very minuscule doses of the med to mitigate its extra effects, until I wipe out the anxiety and chill down? is that even possible?

2) Do I: load up on mood stabilizer(s) to keep things in check? I'm on 150mg of lithium now with a routine of benzos.

3) The third and worst option is to just take the med straight up, and it'll work but I will literally have to be taken care of like a kid, for the next year. My cognition will be gummed up. Memory poorly functioning. And my behaviors and emotions will be messed up. But man will I be mellow.

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On 11/4/2021 at 5:50 PM, ChunkOfCheesecake said:

Down the road I'm looking at a very short course of SSRI treatment to permanently squash anxiety and to mellow down.

The problem is: I have BP, and can react strongly to SSRIs. What's more is SSRIs get into and affect the areas for memory, cognition, and behaviors (it's happened to me and my family members as well).

What do I do about this?

1) Do I:  take very minuscule doses of the med to mitigate its extra effects, until I wipe out the anxiety and chill down? is that even possible?

2) Do I: load up on mood stabilizer(s) to keep things in check? I'm on 150mg of lithium now with a routine of benzos.

3) The third and worst option is to just take the med straight up, and it'll work but I will literally have to be taken care of like a kid, for the next year. My cognition will be gummed up. Memory poorly functioning. And my behaviors and emotions will be messed up. But man will I be mellow.

What does your pdoc say about this?....Did your pdoc suggest the SSRI treatment?.......I would recommend having a discussion with doc about your concerns.

Edited by CrazyRedhead
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17 minutes ago, CrazyRedhead said:

What does your pdoc say about this?....Did your pdoc suggest the SSRI treatment?.......I would recommend having a discussion with doc about your concerns.

Hi, I told him about the anxiety attacks I was having and he was sympathetic. 

I asked him for the SSRI (because I I know it squashes my anxiety); he said "let's wait" -- he knows my history. He also suggested exercise and deep breathing. My issue is:  I was having 30+ anxiety attacks a day when I ran out of benzos-- which was super concerning.

Hence why I wanted to be more aggressive and resolve this anxiety. To rebuild/recover anxiety-free; i.e. so I can sit down on a couch and deeply relax. No heart palps, no bolts of anxiousness.

 

 

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7 hours ago, ChunkOfCheesecake said:

Hi, I told him about the anxiety attacks I was having and he was sympathetic. 

I asked him for the SSRI (because I I know it squashes my anxiety); he said "let's wait" -- he knows my history. He also suggested exercise and deep breathing. My issue is:  I was having 30+ anxiety attacks a day when I ran out of benzos-- which was super concerning.

Hence why I wanted to be more aggressive and resolve this anxiety. To rebuild/recover anxiety-free; i.e. so I can sit down on a couch and deeply relax. No heart palps, no bolts of anxiousness.

Are you back on the benzos..?   If you ran out of your benzos, it's not surprising that your anxiety increased....

Are you on a shorter acting benzo, like Xanax?......If so, it's possible that switching to a longer acting benzo, such as Klonopin (clonazepam), might help provide better anxiety coverage.

Edited by CrazyRedhead
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2 hours ago, CrazyRedhead said:

Are you back on the benzos..?   If you ran out of your benzos, it's not surprising that your anxiety increased....

Are you on a shorter acting benzo, like Xanax?......If so, it's possible that switching to a longer acting benzo, such as Klonopin (clonazepam), might help provide better anxiety coverage.

To provide some history:  Prior to October of this year, I hadn't had an anxiety attack in 15 years. Not a single one. (I wasnt on meds either).

I am on Xanax. I ran out for several days, and out of the blue I had heart palps, rushed feeling, waves of stomach discomfort (this would happen 30 to 40 times a day). They were mild enough where I could still keep my composure.

I don't think it was rebound anxiety from Xanax-- but I'm really hoping, somehow, that's all it is, or at least this anxiety will resolve itself permanently over time.

Otherwise I'm looking at SSRIs which is scary-- but I'm willing to do it, rather than have a lifetime of heart palps and constant disruption.

And yes, Klonopin is a nice idea for longer lasting effect. Xanax surprisingly seems to hold up well throughout the day.

 

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15 hours ago, ChunkOfCheesecake said:

Otherwise I'm looking at SSRIs which is scary-- but I'm willing to do it, rather than have a lifetime of heart palps and constant disruption.

And yes, Klonopin is a nice idea for longer lasting effect. Xanax surprisingly seems to hold up well throughout the day.

 

Other than SSRIs, these  2 other options to maybe ask your doc about would be pregabalin or gabapentin.....

These are used off-label for anxiety.

Edited by CrazyRedhead
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1 hour ago, ChunkOfCheesecake said:

Great-- I presume those only suppress anxiety for as long you take them?

Yes, as far as I know.....I think any drug taken for anxiety, you will have to keep taking it for it to be effective.

Do you have a therapist?.....There are some therapy techniques that can help you cope better with your anxiety.

Edited by CrazyRedhead
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On 11/7/2021 at 10:36 AM, CrazyRedhead said:

Yes, as far as I know.....I think any drug taken for anxiety, you will have to keep taking it for it to be effective.

Do you have a therapist?.....There are some therapy techniques that can help you cope better with your anxiety.

I hear what you're saying.  I have a lot to explore. Also, I don't have a tdoc.

I suppose I keep drifting toward the idea of an SSRI because of how fast it worked for me. The anxiety, intense disposition, quick to be irritated, self-importance, all evaporated immediately. I was so mellow (after the mania and cognitive effects dialed down-- which were so bad). It was liberating. It was permanent. This idea is enticing to me.

But it's a very serious rabbit hole to go down.

---

Side-story:  I was talking to my friend last night and she innocently started joking with me. For no reason I:  instantly started getting intense, anxious, and mad (but I stopped myself). This is new to me-- I basically never do this to her. It was really upsetting because her and I just flow [we were both really mellow people]. I'm like, "my disposition has changed; I'm too intense-- I don't want to be like this. I'll do anything to not be this way. I hate this so much."   Basically, I couldn't enjoy the banter-- similar things have been happening too.

So I'm antsy to fix this, somehow.

 

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1 hour ago, ChunkOfCheesecake said:

I suppose I keep drifting toward the idea of an SSRI because of how fast it worked for me. The anxiety, intense disposition, quick to be irritated, self-importance, all evaporated immediately. I was so mellow (after the mania and cognitive effects dialed down-- which were so bad). It was liberating. It was permanent. This idea is enticing to me.

I'm not sure what you mean by "permanent"....Could you explain?....Do you mean you were mellow while you were taking the SSRI?

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1 hour ago, ChunkOfCheesecake said:

I hear what you're saying.  I have a lot to explore. Also, I don't have a tdoc.

I suppose I keep drifting toward the idea of an SSRI because of how fast it worked for me. The anxiety, intense disposition, quick to be irritated, self-importance, all evaporated immediately. I was so mellow (after the mania and cognitive effects dialed down-- which were so bad). It was liberating. It was permanent. This idea is enticing to me.

But it's a very serious rabbit hole to go down.

---

Side-story:  I was talking to my friend last night and she innocently started joking with me. For no reason I:  instantly started getting intense, anxious, and mad (but I stopped myself). This is new to me-- I basically never do this to her. It was really upsetting because her and I just flow [we were both really mellow people]. I'm like, "my disposition has changed; I'm too intense-- I don't want to be like this. I'll do anything to not be this way. I hate this so much."   Basically, I couldn't enjoy the banter-- similar things have been happening too.

So I'm antsy to fix this, somehow.

 

im trying to think of anything else med wise- i think i mentioned the thought of antipsychotics in another one of your posts. Some people can use hydroxyzine to augment or reduce benzo use. some people can take subtherapeutic doses of antipsychotic prn or daily to counter the anxiety without the ssri risk, with the goal of keeping things calm until talk therapy can help. Have you ever been on one?  I would also say what about trying a higher dose of lithium? if youre on 150 you probably have room. 

oh- extra thought. taking really low doses of ssris can actually be activating in many people and possibly make anxiety worse

extra thought round 2- remeron is an AD that partially acts on serotonin but is thought to have a much lower chance of inducing manic symptoms in bipolar. the tradeoff is drowsiness and hunger cravings which often cause weight gain 

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54 minutes ago, CrazyRedhead said:

I'm not sure what you mean by "permanent"....Could you explain?....Do you mean you were mellow while you were taking the SSRI?

I had meant that, my anxiety never returned. And I stayed pretty mellow; after discontinuing the SSRI.  I couldn't believe after having anxiety (that kept me indoors and would take my breath away) for 15 years that it was just wiped away. it took some getting used to; down-shifting from being that intense to that relaxed and care-free.

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1 hour ago, Iceberg said:

oh- extra thought. taking really low doses of ssris can actually be activating in many people and possibly make anxiety worse

Ah thanks. I was wondering.  Wishful thinking was telling me:  Maybe I could slowly titrate up with the SSRI with miniscule doses and not feel too bad-- then, I would just wake up one morning, and the anxiety (and intense feelings) would be no more again.  Given that SSRIs are really fast acting for me.

I haven't tried an AP, that's an idea.  Talked about lithium with the doc, he said, "well its not necessarily going to calm you down". Remeron sounds like a possibility-- I will look into that.  What about Buspar?

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4 hours ago, ChunkOfCheesecake said:

Ah thanks. I was wondering.  Wishful thinking was telling me:  Maybe I could slowly titrate up with the SSRI with miniscule doses and not feel too bad-- then, I would just wake up one morning, and the anxiety (and intense feelings) would be no more again.  Given that SSRIs are really fast acting for me.

I haven't tried an AP, that's an idea.  Talked about lithium with the doc, he said, "well its not necessarily going to calm you down". Remeron sounds like a possibility-- I will look into that.  What about Buspar?

could be worth a shot, low side effect profile, my pdocs (past and present) have been skeptical of its efficacy. its often all or nothing some people get a good response but many don't feel it at all, but if you want to try something more mild it might be worth a look.

With the lithium, i think it is more helpful when the anxiety isn't independent of the bipolar, but it seems like that isnt the case for you 

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15 hours ago, ChunkOfCheesecake said:

I had meant that, my anxiety never returned. And I stayed pretty mellow; after discontinuing the SSRI.  I couldn't believe after having anxiety (that kept me indoors and would take my breath away) for 15 years that it was just wiped away. it took some getting used to; down-shifting from being that intense to that relaxed and care-free.

Interesting......How long did that remission from the anxiety last?.....Just curious.

Edited by CrazyRedhead
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23 hours ago, CrazyRedhead said:

Interesting......How long did that remission from the anxiety last?.....Just curious.

Remission was from 2007 up until this October. 

What changed:  I was still feeling a little anhedonic, and unengaged from the SSRI-- so I did a short trial (7x75mg tabs) of Wellbutrin this October.

The result:  I went manic that turned dangerously depressive; it turned into an emergency, and had to go on medications to mitigate.  I seem to now have anxiety (it's hard to tell lately given I'm on a regimen of Xanax --twice a day-- and I'm steering clear of all stress). Irritable, uptight, hyperfocusing, depressed, seem to be the new reality now.  (With all that has happened, I suppose it will take some time for everything to settle to see where things really are for the long term).

Edited by ChunkOfCheesecake
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17 hours ago, Iceberg said:

could be worth a shot, low side effect profile, my pdocs (past and present) have been skeptical of its efficacy. its often all or nothing some people get a good response but many don't feel it at all, but if you want to try something more mild it might be worth a look.

With the lithium, i think it is more helpful when the anxiety isn't independent of the bipolar, but it seems like that isnt the case for you 

I heard about it also as having less occurrence, or chance, of triggering mania. I'll think about trying it.

Yes that's the big issue-- this anxiety isn't tied to the BP; it runs on the typical unipolar track.  i.e. I have to play with serotonin (which is risky) or use tranquilizers or APs. I haven't had anxiety lately because I'm on xanax twice a day-- I'll need to stop taking it for a while to see where I actually stand with anxiety (maybe by some miracle the anxiety is actually resolved-- yeah right).

 

 

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  • 3 weeks later...

To update this thread:

The bad relentless mania officially stopped, a few days ago. What a nightmare. For now, I feel better (w/ milder hypomania shifts; positive mood).

Stopped meds many days ago (only tiny doses of benzos now); they should be cleared out by now.

With all that said, I still feel intense. Stuck in an anxious state. (I'm hyperfocusing too-- and I sense that obsessiveness is just right around the corner.)

No anxiety attacks during the day. But I'll have quick "flutters" in the A.M.

So now it's a tough call on what to even do.

The anxiety attacks were the deal-breaker.

But I still don't want my permanent baseline to be an anxious, uptight, obsessive, intense one. I lived that life already, but worse.

I don't know, I guess I'll wait and see if this intensity goes away (I give it a 5% chance).

I feel like I shouldnt wait too long-- things might get more confusing (i.e. I'll accept it; justify it; forget, or lose sight of how I think/know I should feel, etc).

More fun updates later.

 

 

 

 

Edited by ChunkOfCheesecake
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@ChunkOfCheesecake, does your pdoc know you have stopped all meds?.....You say you have bipolar disorder, but don't say whether it's BP 1, or BP 2.

According to WebMD, there is no permanent "cure" for bipolar, but it can be managed with the proper medications and therapy:

"There is no cure for bipolar disorder, but through behavior therapy  and the right combination of mood stabiliazers and other bipolar medicines, most people with bipolar disorder can live normal productive lives and control the illness.     That said, bipolar disorder is a lifelong mental illness that has a great risk of recurrent episodes      Taking prescribed medications and keeping doctor appointments are crucial to self- managing bipolar disorder and preventing serious episodes.."

https://www.webmd.com/bipolar-disorder/guide/preventing-bipolar-disorder#:~:text=There is no cure for,lives and control the illness.

IMO, you really do need to see your pdoc ASAP......Please don't wait any longer.....Only pdoc can decide what meds you need to treat your bipolar.

Please trust your pdoc and get some treatment--that's the best advice I can give.

 

Edited by CrazyRedhead
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@CrazyRedhead- Thank you; with experience, I recognize I'm in a dial-down phase now. At some point soon, I won't have major symptoms.

I forgot to mention, 95% to 99% of the time in my life I'm not on any meds (save for an occasional ibuprofen), and I feel alright.

I'm returning to that place, thankfully.

I still have a rough road, with a lot to sort out; and deciding which direction I should go-- hence my lovely blog posts :]

Typically, I'm probably cyclothymic on the scale, and don't fit into the major titles.

But: When I play with psychotropic (reuptake) meds it exacerbates (a lot!). And puts me somewhere else--temporarily.

(That's why this is all upsetting-- I know better than to put myself in this situation.)

 

 

Edited by ChunkOfCheesecake
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