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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Dale on June 22, 2001, at 15:21:56
Hello,
I am new to this list and I am going through some tough
times right now. I have been on 100 mg of zoloft for about 2 1/2 years
and 4 months ago the doctor decided to take me down to 75, then to 50.
I became depressed after going down to 50, so he told me to
go back up to 75 and maybe that would be my dose. Well, after
a little while I started developing tics where I would jerk
my neck, tense my stomach, and jerk my legs too. After a bout of
anxiety (induced, i feel, from caffeine) I went to see him about a month ago
and he told me this:To go back down to 50mg on zoloft, and he will start switching me over to
Paxil. So, while going off zoloft he started the Paxil. I went down to 50mg, but
waited a week and then started the 10mg of Paxil, which I started this past monday (
so I have been on the paxil for almost 5 days now) while being on 50 mg of
zoloft. Next Monday I am suppsed to go down to 25mg zoloft and
go up 20mg on Paxil.The doctor prescribing this is my general family doctor.
Last night I got myself all scared by doing a bit of research. I found
the book Prozac Backlash , by Joseph Glenmullen, M.D. (Harvard MEdical School),
and started reading it. Wow - it sounded like me. He talked about people being on
SSRIs (Prozac, Zoloft, Paxil) and how the medicine masks tics until you start going off of them,
which I was doing. He also said that the neurological disorders such as
facial and whole-body tics can indicate brain damage! He also talked about tardive dyskinesia (tics), and parkinson-like
movements. This really scared me and just finding this out while going off zoloft and onto paxil
makes me wonder if I should forget the paxil and just continue to go off the zoloft.Any suggestions? I feel like my life is falling before me! My mind is not like it used to be -
I feel dumber, do not conentrate as well, lost interest in my normal activities, feel "out of it," no energy either!
Ahhhh. It would REALLY help me to get some responses from some of you. Hope to hear from you soon.Yours,
Dale
Posted by Noa on June 22, 2001, at 15:50:29
In reply to Zoloft to Paxil - Tics - HELP!!!, posted by Dale on June 22, 2001, at 15:21:56
Dale,
I believe what you are experiencing is nothing permanent. I, too, have dose-related muscle twitches from SSRIs. For me, it was worst with Paxil, but I also have had it with Effexor. It is also called myoclonus. For me, it happened most frequently when at rest, like just before going to sleep or when lying on the sofa. Muscles that I could not possible flex on purpose would suddenly flex or twitch.
For me, caffeine also added to the problem.
What worked for me was lowering the dose, as well as combining the Effexor with Serzone, which blocks the action of the 5HT-2 serotonin receptor, which is one of the receptors involved in muscle action.
I believe you should see a psychopharmocologist to develop a strategy for medications. I believe it is probably beyond the expertise of a family doctor.
But I encourage you not to get caught up in the "backlash" stir. If what you have experienced is the same as what I have (I can't say if it is or isn't, but it sounds familiar), it is not a real tic disorder, it is not an enduring problem, it does not cause brain damage. It is dose dependent and reversible.
Posted by Sulpicia on June 22, 2001, at 20:40:08
In reply to Zoloft to Paxil - Tics - HELP!!!, posted by Dale on June 22, 2001, at 15:21:56
> Hi--
you wrote:Last night I got myself all scared by doing a bit of research. I found
the book Prozac Backlash , by Joseph Glenmullen, M.D. (Harvard MEdical School),
and started reading it. Wow - it sounded like me. He talked about people being on
SSRIs (Prozac, Zoloft, Paxil) and how the medicine masks tics until you start going off of them,
which I was doing. He also said that the neurological disorders such as
facial and whole-body tics can indicate brain damage! He also talked about tardive dyskinesia (tics), and
parkinson-like
movements. This really scared me and just finding this out while going off zoloft and onto paxil
makes me wonder if I should forget the paxil and just continue to go off the zoloft."Tics and tardive dyskinesia are 2 different things, and from the title of the book you read, the last thing
the author is concerned about is your mental health. There is an agenda here, and whether it's anti-psychiatry
in general, like the Scientologists, or some litigeous nonsense, let it go.Tics are transient involuntary movements -- if they remain, both vocal and motor, for at least 1 year
you are diagnosed with Tourettes Syndrome. Onset is at or around andrarche -- no adult onset.
Tardive dyskinesia is a movement disorder [see the WeMove web site, best movement disorder site ever] and
it's a real *pet* of anti-med types because it was a major side effect of the first generation of anti-psychotics
like haldol.In the new anti-psychotics and SSRIs, TD is extremely, extremely rare. It commonly happens after you've been on a med for several years.
And as rare as it is, it's even more extremely rare that it happens while lowering the dose or stopping a med.
Folks with an agenda latch onto this tiny, and
questionable number of patients to raise an unwarranted alarm about psych meds in general. Go and learn a bit about it to
make yourself feel a bit better.I can't tell whether you're experiencing TD or not, but strange sensations can accompany med cessations.
In principle I dislike GP's dealing with AD meds and I can't understand why he lowered your dose to a sub-theraputic
range. If he wanted to see if you would relapse he could have suggested you stop and see -- the dosing strategy seems to
be odd.
Can you have a pdoc supervise or consult as you move onto paxil, and just to reassure you about the twitches? And it's
probably rather important that you see a specialist because you've demonstrated that you still need the med. A pdoc
is the one who can help you evaluate maintainance therapy.As for the tardive dyskinesia being an indication of brain damage, since it virtually always stops when the SSRI
is withdrawn, how accurate do you suppose this doc's claim is?Feel better soon,
Posted by Dale on June 24, 2001, at 11:06:48
In reply to Re: Zoloft to Paxil - Tics - HELP!!! » Dale, posted by Sulpicia on June 22, 2001, at 20:40:08
Sulpicia,
Thanks so much for your reply. It helps me the most to get replys from other people. I do not know if the author of the book I spoke of is ant-psychiatric - he is a psychiatrist at the Harvard Medical School. There is so much information out there today that it is hard to know what to believe anymore!
I can see your point and it made me feel better. Now that I look back on my life (I am 30), I wonder is I have always had Turettes - I am always flexing a muscle, raising eyebrows, blinking, etc. Recently, when I went down to 75mg of zoloft and stayed there awhile it seems odd that I developed something different - and it feels very different than things in the past - when stressed a twitching around my left eye, jerking motion in my neck, flexing my abdominal muscles. I noticed that for quite some time now I also put air in my cheeks and perse my lips too.
It was only very recently that I thought of the possibility of Turettes, and then I found this tardive dyskinesia, which sounds so much like what I have.
I am also worried about taking the paxil as I go off the zoloft - at the same time - which I hope does not screw me up too much. Do you think the muscle jerking could go away on the paxil, or do you think being on any AD will cause these problems?
Thanks, and talk to you soon.
Dale
Posted by Dale on June 24, 2001, at 11:06:54
In reply to Re: Zoloft to Paxil - Tics - HELP!!! » Dale, posted by Sulpicia on June 22, 2001, at 20:40:08
Sulpicia,
Thanks so much for your reply. It helps me the most to get replys from other people. I do not know if the author of the book I spoke of is ant-psychiatric - he is a psychiatrist at the Harvard Medical School. There is so much information out there today that it is hard to know what to believe anymore!
I can see your point and it made me feel better. Now that I look back on my life (I am 30), I wonder is I have always had Turettes - I am always flexing a muscle, raising eyebrows, blinking, etc. Recently, when I went down to 75mg of zoloft and stayed there awhile it seems odd that I developed something different - and it feels very different than things in the past - when stressed a twitching around my left eye, jerking motion in my neck, flexing my abdominal muscles. I noticed that for quite some time now I also put air in my cheeks and perse my lips too.
It was only very recently that I thought of the possibility of Turettes, and then I found this tardive dyskinesia, which sounds so much like what I have.
I am also worried about taking the paxil as I go off the zoloft - at the same time - which I hope does not screw me up too much. Do you think the muscle jerking could go away on the paxil, or do you think being on any AD will cause these problems?
Thanks, and talk to you soon.
Dale
Posted by Dale on June 24, 2001, at 11:07:45
In reply to Re: Zoloft to Paxil - Tics - HELP!!! » Dale, posted by Sulpicia on June 22, 2001, at 20:40:08
Sulpicia,
Thanks so much for your reply. It helps me the most to get replys from other people. I do not know if the author of the book I spoke of is ant-psychiatric - he is a psychiatrist at the Harvard Medical School. There is so much information out there today that it is hard to know what to believe anymore!
I can see your point and it made me feel better. Now that I look back on my life (I am 30), I wonder is I have always had Turettes - I am always flexing a muscle, raising eyebrows, blinking, etc. Recently, when I went down to 75mg of zoloft and stayed there awhile it seems odd that I developed something different - and it feels very different than things in the past - when stressed a twitching around my left eye, jerking motion in my neck, flexing my abdominal muscles. I noticed that for quite some time now I also put air in my cheeks and perse my lips too.
It was only very recently that I thought of the possibility of Turettes, and then I found this tardive dyskinesia, which sounds so much like what I have.
I am also worried about taking the paxil as I go off the zoloft - at the same time - which I hope does not screw me up too much. Do you think the muscle jerking could go away on the paxil, or do you think being on any AD will cause these problems?
Thanks, and talk to you soon.
Dale
Posted by Sulpicia on June 24, 2001, at 22:59:08
In reply to Re: Zoloft to Paxil - Tics - HELP!!!, posted by Dale on June 24, 2001, at 11:06:48
> Dale--
It's funny you should wonder about having Tourettes [TS, please -- long day typing!] -- I spend a good deal of time attempting to bring sanity to an ADHD forum and since TS is often comorbid with ADHD, I've communicated with a fair number of moms who discover they have TS when their kids are diagnosed with it. Many recall relatives who had quirky movements that they now recognize as tics.
And since TS is most often mild it's not totally strange that you didn't pay much attention to it.First, have a look at the Tourettes Society of America web site -- try TSA.org
and see if SSRI meds have been known to exacerbate tics. Also see if you can find a referral to an experienced neurologist near you or a TS clinic. Not all neuros have a good understanding of TS.
I would strongly suggest that you see a neurologist or a movement disorder specialist to find out what precisely is happening to you. You should rule out the remote possibility of tardive dyskinesia since you're moving to another SSRI med.Not having read the book in question I leaped to the conclusion because of the title and my own personal experience with what seems to be a growing cottage industry of sorts -- several forums I read have been inundated with post about tardive D. by trolls within the last month or so. Their info is totally wrong and laughably enough, they keep getting their horror stories wrong, or in one case, their gender. TD is extremely REMOTE in SSRIs. As for the Harvard Med pedigree, it's impressive indeed until you stop to think that on the University of Pennsylvania med school faculty [child neuro] is a doc who writes frequently that ADHD doesn't exist and children < 18 don't get depressed. Go figure.
The symptoms you describe may indeed be waxing TS but I'm not an expert and you clearly must have a diagnosis. I don't know if SSRIs cause an increase in tics but stress certainly does -- switching off the zoloft more than qualifies as a whopping dose of stress, not to mention treatment for depression, and depression itself.
I also might insist on an urgent appt. with the neuro or movement specialist: presumably you're not taking AD meds on a whim but rather need them to be effective -- it sounds like the last thing you need is to be waffling around sans meds. An experienced clinician should be able to put your mind at ease and if necessary suggest meds that don't increase tics.
Do be careful of your sources of information -- tardive D. seems to be a hot bottom for a veritable army of anti-med folks.
I hope you're a bit more comfortable now?
what does your pdoc say about all this?
S.
>
This is the end of the thread.
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