clinic Posted September 22, 2019 Share Posted September 22, 2019 (edited) I want to take SSRI but i get crying spells on them except Paroxetine. Only paroxetine is tolerable but it is not working for anxiety. I want to take another SSRI but I'm fed up trying them as I start feeling like crying or sometimes I actually cry. My pdoc theory is that I quit SSRI too soon for it to work. He told me to take low dose benzo along with SSRI. But i have to take really high benzo like clobazam 20mg for me to tolerate SSRI. But if i reduce my benzo i start crying again. And high dose benzo causes severe sedation and cognitive decline I dont know what to do. Edited September 30, 2019 by clinic Link to comment Share on other sites More sharing options...
CrazyRedhead Posted September 22, 2019 Share Posted September 22, 2019 1 hour ago, clinic said: I dont know what to do. It seems to me like you really need a second opinion from another pdoc.....Is that an option for you? Link to comment Share on other sites More sharing options...
notloki Posted September 22, 2019 Share Posted September 22, 2019 https://www.newscientist.com/article/mg20727694-400-bit-of-a-crybaby-blame-your-serotonin-levels/ 1 Link to comment Share on other sites More sharing options...
mikl_pls Posted September 23, 2019 Share Posted September 23, 2019 What antidepressants have you tried, @clinic? Have you tried any SNRIs? TCAs? MAOIs? Link to comment Share on other sites More sharing options...
clinic Posted September 23, 2019 Author Share Posted September 23, 2019 12 hours ago, mikl_pls said: What antidepressants have you tried, @clinic? Have you tried any SNRIs? TCAs? MAOIs? Antidepressants Fluoxetine 20mg → crying spells unless taken with high dose benzo clobazam 20mg Escitalopram 5mg → crying spells unless taken with high dose benzo clobazam 20mg Desvenlafaxine 100mg → crying spells unless taken with high dose benzo clobazam 20mg Vilazodone → crying spells unless taken with high dose benzo clobazam 20mg Sertraline 50mg → worsening paranoia Clomipramine 25 → worsening psychosis Link to comment Share on other sites More sharing options...
mikl_pls Posted September 23, 2019 Share Posted September 23, 2019 47 minutes ago, clinic said: Antidepressants Fluoxetine 20mg → crying spells unless taken with high dose benzo clobazam 20mg Escitalopram 5mg → crying spells unless taken with high dose benzo clobazam 20mg Desvenlafaxine 100mg → crying spells unless taken with high dose benzo clobazam 20mg Vilazodone → crying spells unless taken with high dose benzo clobazam 20mg Sertraline 50mg → worsening paranoia Clomipramine 25 → worsening psychosis Thanks for the list; I just wish I had thought to look in your signature, that would've saved you a lot of trouble! (oops!) So it seems like anything specifically serotonergic makes you have crying spells, but anything remotely noradrenergic or dopaminergic (or both, since NRIs increase dopamine in the PFC...) worsen psychosis. I assume you've been taking serotonergic meds long enough to downregulate the presnypatic 5-HT1A autoreceptors to disinhibit the feedback loop of serotonin release, as well as 5-HT2A and 5-HT2C receptors, am I right? Have you considered something with 5-HT1A antagonist properties, like the beta-blocker pindolol (if it's available where you live)? That's really the only thing I can think of. It's strange that SSRIs, SNRIs, and TCAs make you have crying spells, yet paroxetine doesn't (it's an SNRI in high doses as you know I'm sure). I just can't pinpoint even remotely what could be causing this... Perhaps it could be something related to clozapine? Link to comment Share on other sites More sharing options...
clinic Posted September 24, 2019 Author Share Posted September 24, 2019 (edited) 23 hours ago, mikl_pls said: Thanks for the list; I just wish I had thought to look in your signature, that would've saved you a lot of trouble! (oops!) So it seems like anything specifically serotonergic makes you have crying spells, but anything remotely noradrenergic or dopaminergic (or both, since NRIs increase dopamine in the PFC...) worsen psychosis. I assume you've been taking serotonergic meds long enough to downregulate the presnypatic 5-HT1A autoreceptors to disinhibit the feedback loop of serotonin release, as well as 5-HT2A and 5-HT2C receptors, am I right? Have you considered something with 5-HT1A antagonist properties, like the beta-blocker pindolol (if it's available where you live)? That's really the only thing I can think of. It's strange that SSRIs, SNRIs, and TCAs make you have crying spells, yet paroxetine doesn't (it's an SNRI in high doses as you know I'm sure). I just can't pinpoint even remotely what could be causing this... Perhaps it could be something related to clozapine? Yea beta blockers also give me crying spells. When i was on clozapine 100mg, I could tolerate any SSRI. When i had relapse we increased clozapine to 200mg, thats when i stopped tolerating any SSRI. All gave me crying spells. There is a study which says clozapine worsens anxiety symptoms here --> https://pdfs.semanticscholar.org/2c84/f4256c6602634dbab1e23942307f0ac0883d.pdf Right now if I take high dose benzo like clobazam 20mg and take SSRI. I can tolerate them but if benzo is reduced, I cant tolerate any SSRI at all. I have just updated my about me page, all the meds i have tried https://www.crazyboards.org/profile/40990-clinic/?tab=field_core_pfield_13 Edited September 24, 2019 by clinic Link to comment Share on other sites More sharing options...
mikl_pls Posted September 24, 2019 Share Posted September 24, 2019 4 hours ago, clinic said: Yea beta blockers also give me crying spells. Well darn! There goes that idea. 4 hours ago, clinic said: When i was on clozapine 100mg, I could tolerate any SSRI. When i had relapse we increased clozapine to 200mg, thats when i stopped tolerating any SSRI. All gave me crying spells. There is a study which says clozapine worsens anxiety symptoms here --> https://pdfs.semanticscholar.org/2c84/f4256c6602634dbab1e23942307f0ac0883d.pdf Right now if I take high dose benzo like clobazam 20mg and take SSRI. I can tolerate them but if benzo is reduced, I cant tolerate any SSRI at all. I have just updated my about me page, all the meds i have tried https://www.crazyboards.org/profile/40990-clinic/?tab=field_core_pfield_13 Interesting about clozapine increasing anxiety symptoms. Perhaps that could be the culprit? Do you think you could get your pdoc to lower your clozapine and add an adjunctive agent? I seem to remember aripiprazole made you worse. Is Rexulti or Vraylar available where you live? What about Latuda? Loxapine? Haloperidol? Trifluoperazine? (I'm not sure what all antipsychotics you've tried...) Link to comment Share on other sites More sharing options...
clinic Posted September 25, 2019 Author Share Posted September 25, 2019 (edited) 16 hours ago, mikl_pls said: Well darn! There goes that idea. Interesting about clozapine increasing anxiety symptoms. Perhaps that could be the culprit? Do you think you could get your pdoc to lower your clozapine and add an adjunctive agent? I seem to remember aripiprazole made you worse. Is Rexulti or Vraylar available where you live? What about Latuda? Loxapine? Haloperidol? Trifluoperazine? (I'm not sure what all antipsychotics you've tried...) I tried olanzapine 2.5mg for 2 days but it was making my cognition worse so i stopped it. I was not able to say sentences properly, thoughts stop in the middle of a sentence, confused about what i wanna say I think i stop meds too soon. Maybe that cognition side effect will go away ? We can start with olanzapine 2.5mg for 1 week then 5mg from 2nd week. Then we reduce clozapine from 175 to 100mg Edited September 25, 2019 by clinic Link to comment Share on other sites More sharing options...
clinic Posted September 25, 2019 Author Share Posted September 25, 2019 Just got a text from pdoc, he said i can try olanzapine again. Link to comment Share on other sites More sharing options...
clinic Posted September 30, 2019 Author Share Posted September 30, 2019 (edited) @mikl_pls I stopped paroxetine about a week ago. I started it again and now I'm on my 2nd week(taking 25mg) and I can't explain how much better i feel, my mood is very happy plus i feel like my cognition(problem solving skills and somewhat memory) has improved as well. I used to take 12.5 in morning and 25mg in evening. My mood and cognition is only better after evening 25mg dose. In morning i dont feel much mood/cognition improvements after taking 12.5mg dose. If i increase my morning dose i feel sleepy. So far i can tolerate total 37.5mg. I've tried 50mg but i get restless and crying feeling on it. Maybe I can try half of 12.5mg, that would be 37.5 + 6.25 = total 43.75mg dose So my question is should i try increasing morning dose from 12.5 to 25mg and see if sedation improves ? Will I stilll feel cognition improvements if I'm feel sleepy ? I've read your memory goes down if your feeling sleepy. Paroxetine works for mood or maybe ocd. But it is not helping panic disorder(only my benzo clobazam works). But i get cognitive and memory decline on benzo. Thats my 2.5 year experience on it. I will also decrease my benzo to improve cognition. I dont know why i tolerate paroxetine and not other SSRIs. I get crying spells on the very 1st day on them I'm brainstorming this study[1], to see which antidepressant i should try for anxiety. Check out page 1363 or page 7 on your pdf. [1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext [1 pdf] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2817%2932802-7 Edited September 30, 2019 by clinic Link to comment Share on other sites More sharing options...
Iceberg Posted September 30, 2019 Share Posted September 30, 2019 33 minutes ago, clinic said: @mikl_pls I stopped paroxetine about a week ago. I started it again and now I'm on my 2nd week(taking 25mg) and I can't explain how much better i feel, my mood is very happy plus i feel like my cognition(problem solving skills and somewhat memory) has improved as well. I used to take 12.5 in morning and 25mg in evening. My mood and cognition is only better after evening 25mg dose. In morning i dont feel much mood/cognition improvements after taking 12.5mg dose. If i increase my morning dose i feel sleepy. So far i can tolerate total 37.5mg. I've tried 50mg but i get restless and crying feeling on it. Maybe I can try half of 12.5mg, that would be 37.5 + 6.25 = total 43.75mg dose So my question is should i try increasing morning dose from 12.5 to 25mg and see if sedation improves ? Will I stilll feel cognition improvements if I'm feel sleepy ? I've read your memory goes down if your feeling sleepy. Paroxetine works for mood or maybe ocd. But it is not helping panic disorder(only my benzo clobazam works). But i get cognitive and memory decline on benzo. Thats my 2.5 year experience on it. I will also decrease my benzo to improve cognition. I dont know why i tolerate paroxetine and not other SSRIs. I get crying spells on the very 1st day on them I'm brainstorming this study[1], to see which antidepressant i should try for anxiety. Check out page 1363 or page 7 on your pdf. [1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext [1 pdf] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2817%2932802-7 So bump to 50 total? You might want to give the current dose a little more time but obviously that depends on your pdocs prescribing strategy. As far as anxiety- Paxil is pretty good in that department... so are you looking for an add on or a total switch to something new? Link to comment Share on other sites More sharing options...
clinic Posted September 30, 2019 Author Share Posted September 30, 2019 (edited) 51 minutes ago, Iceberg said: So bump to 50 total? You might want to give the current dose a little more time but obviously that depends on your pdocs prescribing strategy. As far as anxiety- Paxil is pretty good in that department... so are you looking for an add on or a total switch to something new? Yea i have tried 50mg for 1-2 days. It makes me feel like crying and gives me palpitations. Should i give it more days ? Maybe i can split 12.5mg in half and try total 43.75mg instead. I've not tried 43.75mg though I'm looking for add on. I'm not going to stop paxil ever cuz my mood is too good on it. I just dont know why i tolerate paxil and not other SSRIs. I dont want ADs which increase dopamine cuz that might worsen psychosis just like sertraline does for me Edited September 30, 2019 by clinic Link to comment Share on other sites More sharing options...
clinic Posted September 30, 2019 Author Share Posted September 30, 2019 Also as i taper paroxetine up to 37.5mg, right now on 2nd week on 25mg im feeling slight like crying and dry mouth in afternoon. I hope it goes away in 3rd week Link to comment Share on other sites More sharing options...
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