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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by tiopenster on May 21, 2010, at 8:07:55
I have been taking Geodon at 60mg for anxiety for about 18 months. I've been really stable anxiety wise, but I don't like the sleepiness and cognitive effects. I went down the 40mg and my anxiety shot up. It's been 5 days now and the anxiety isn't as bad as day 2, but 3-5 have still had anxiety. Is this just part of withdrawal or is it the return of my anxiety? How long does withdrawal last?
Posted by Phillipa on May 21, 2010, at 10:54:26
In reply to Is this Geodon withdrawal, posted by tiopenster on May 21, 2010, at 8:07:55
If you were stable at the higher dose could you maybe add some back in? Phillipa
Posted by Phidippus on May 21, 2010, at 16:49:12
In reply to Is this Geodon withdrawal, posted by tiopenster on May 21, 2010, at 8:07:55
I took Geodon for 3 months and stopped it cold without any anxiety related effects. I'm sure you must be experiencing rebound anxiety.
P
Posted by Brainbeard on May 22, 2010, at 14:17:39
In reply to Is this Geodon withdrawal, posted by tiopenster on May 21, 2010, at 8:07:55
I've been on 5-40mg of Geodon for a couple of months, then gradually tapered down. I experienced a severe withdrawal syndrome. I had very physical anxiety attacks, of a sort I had hardly ever experienced before. There would be this stone in my stomach and nothing could relief my anxiety except high dose benzo's. It was also weird that while I normally have very specific fears, the anxiety was completely non-specific. I was just plain anxious.
Geodon is a potent blocker of a subtype of serotonin receptors (5HT2A receptors) involved in anxiety, sleep and appetite, among other things. When you withdraw from any potent 5HT2A-blocker, these receptors have to readjust and will get activated at first. This causes a typical kind of anxiety. Activation of these receptors is also the cause of increased anxiety when starting up an SSRI.
What could actually help is to substitute Geodon for a milder 5hT2A-blocker, like pipamperone or trimipramine. I would look out for any QT-interval interactions though.
Posted by Phillipa on May 22, 2010, at 21:31:25
In reply to Re: Is this Geodon withdrawal, posted by Brainbeard on May 22, 2010, at 14:17:39
Brainbeard do you know you are the only person that has explained to me how and why there is startup anxiety with SSRI's. That I understand. I don't understand the letters and numbers though just that the cause of start up anxiety in SSRI's is like with drawal from geodon a temporary adjustment of the brain. Did I get it right or wrong? Phillipa
Posted by Brainbeard on May 23, 2010, at 5:03:19
In reply to Re: Is this Geodon withdrawal » Brainbeard, posted by Phillipa on May 22, 2010, at 21:31:25
Well, Philippa, to explain it further, SSRI's start flushing your brain with serotonin, so that ALL serotonin receptor types get triggered wildly. One of the theories behind the effectiveness of SSRI's is that certain receptors desensitize after a couple of weeks to months. Perhaps even longer for some subtypes. Once certain receptors, like the ones mentioned, have been 'triggered numb', a therapeutic effect could kick in.
The story of 5HT2A-receptors makes clear that it would make sense to add certain drugs to an SSRI to make it work faster and to avoid the nastiest start-up side-effects. Currently, a patented combination of citalopram (Celexa) and pipamperone (Dipiperone, an antipsychotic that is a potent 5HT2A-blocker) is underway. The TCA's that work on serotonin all block 5HT2A-receptors to some extent, which is probably one of the reasons they tend to work faster than SSRI's.
So yeah, you're right, the start-up anxiety provoked by SSRI's is akin to the withdrawal anxiety experienced when quitting Geodon.
(A note to Dr. Bob: I'm trying to keep stuff simple enough to avoid being moved to 'Neurotransmitters', where I wouldn't have taken such pains.)
Posted by Phillipa on May 23, 2010, at 19:00:04
In reply to Re: Is this Geodon withdrawal, posted by Brainbeard on May 23, 2010, at 5:03:19
But this exactly what a lot of posters have said the technical stuff not understood. This is teaching. Thank you. Much appreciated. Phillipa
Posted by Brainbeard on May 24, 2010, at 3:22:06
In reply to Re: Is this Geodon withdrawal » Brainbeard, posted by Phillipa on May 23, 2010, at 19:00:04
Posted by Dr. Bob on May 24, 2010, at 15:05:36
In reply to Re: Is this Geodon withdrawal, posted by Brainbeard on May 23, 2010, at 5:03:19
> (A note to Dr. Bob: I'm trying to keep stuff simple enough to avoid being moved to 'Neurotransmitters', where I wouldn't have taken such pains.)
Thanks. Please feel free to post something to Neurotransmitters in addition to here. And to link to it from here.
Bob
Posted by Brainbeard on May 25, 2010, at 8:07:31
In reply to Re: the Neurotransmitters board » Brainbeard, posted by Dr. Bob on May 24, 2010, at 15:05:36
> > (A note to Dr. Bob: I'm trying to keep stuff simple enough to avoid being moved to 'Neurotransmitters', where I wouldn't have taken such pains.)
>
> Thanks. Please feel free to post something to Neurotransmitters in addition to here. And to link to it from here.
>
> Bob
Good idea, thank you.
This is the end of the thread.
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