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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by g_g_g_unit on April 21, 2011, at 22:32:17
If I'm experiencing movement problems (restless arms and legs, muscle twitches, etc.) and mild akathisia on day#2 of just 25mg of Zoloft, is there any sense in proceeding with the trial? I won't be able to contact my psychiatrist for 4 days, so I'm a little nervous. These side-effects were present, albeit not as noticeably, at 12.5mg.
I had similar problems with my last two AD trials - Prozac and Clomipramine - so am debating whether it would be better to just find some way around them, in a bid to treat OCD?
Posted by Christ_empowered on April 22, 2011, at 1:13:23
In reply to SSRI akathisia, posted by g_g_g_unit on April 21, 2011, at 22:32:17
hey. Sorry about your problems. I personally wouldn't continue taking something that was causing akathisia. I guess you could wait it out or try the lower dose and then call your doc for a benzo or something. Really your call.
If you're this sensitive to meds at low doses during short-term use, I'd be concerned about long-term ill effects. Benzos can be used for OCD; amphetamines are also used. You may want to explore alternative forms of treatment.
Posted by g_g_g_unit on April 22, 2011, at 2:05:01
In reply to Re: SSRI akathisia, posted by Christ_empowered on April 22, 2011, at 1:13:23
Hey, thanks for responding. To be honest, I'm still not clear on whether or not it's akathisia because the 'restlessness' I experience tends to vary in nature and intensity on different drugs. For example, on Seroquel, I had a compulsion to move accompanied by agitation, a sense of misery and doom, etc. which was pretty obviously akathisia.
On Prozac, I recall experiencing a Seroquel-like akathisia at the beginning of treatment. The longer I stayed on it, however, the worse my sleep became due to leg twitches, etc. and I remember growing very hyperactive and restless during the day, but without that same sense of doom which I know is a trademark of akathisia. My parents thought I was 'cured' because I was so enthusiastic and playful around my brothers, but I really just felt miserable and out-of-control.
The way I feel on Zoloft echoes my Prozac experience, i.e. I'm hyperactive, playful but with this weird intensity and secretly feel like hell due to not sleeping properly. So I'm not sure if the restlessness is more mood-related, or due to disrupted attention from sleep, or really a mild form of akathisia. I find that nicotine gum improves the anxiety, attention and restlessness.
Yeah, it sucks that I experience such intense side-effects at such low-doses. So while it seems logical to come off the drug, there really isn't much left that I haven't tried, which is why I was wondering if I should try work around the problem or see if it passes with time.
Amphetamine made my OCD worse. I tried Xanax, but didn't particularly like it.
> hey. Sorry about your problems. I personally wouldn't continue taking something that was causing akathisia. I guess you could wait it out or try the lower dose and then call your doc for a benzo or something. Really your call.
>
> If you're this sensitive to meds at low doses during short-term use, I'd be concerned about long-term ill effects. Benzos can be used for OCD; amphetamines are also used. You may want to explore alternative forms of treatment.
Posted by Phillipa on April 22, 2011, at 11:35:33
In reply to Re: SSRI akathisia » Christ_empowered, posted by g_g_g_unit on April 22, 2011, at 2:05:01
How bout luvox and ativan as ativan doesn't metabolize the same as other benzos with luvox? Phillipa
Posted by creepy on April 26, 2011, at 13:25:25
In reply to SSRI akathisia, posted by g_g_g_unit on April 21, 2011, at 22:32:17
Ive had luck with benadryl and beta-blockers for that. Would be optimal if the restlessness comes up more often when youre trying to sleep.
Id tough it out if you can. Oddly, zoloft hasnt given me any side effects except anorgasmia. Its been better than the other SSRIs Ive tried.
Posted by mtdewcmu on April 26, 2011, at 15:04:33
In reply to Re: SSRI akathisia » Christ_empowered, posted by g_g_g_unit on April 22, 2011, at 2:05:01
I experienced restlessness on Zoloft that never went away even after months. It's a shame, because otherwise it seemed like a great drug. I had similar problems with Prozac. I would recommend trying one of the more "sedating" SSRIs, which is basically any SSRI other than Prozac and Zoloft. Celexa seems to be the sweet spot for me. I also tolerated Paxil, but had other nasty side effects.
Posted by hopefullynow on April 28, 2011, at 1:13:15
In reply to You probably should switch SSRIs, posted by mtdewcmu on April 26, 2011, at 15:04:33
I want to throw my two cents here about SSRI's, TCA's and akathisia.
Ever since my SA, depression, etc started, about 12 years ago, I was put on serotonergic drugs.The pattern was 2-3 days after treatment initiation, I was feeling better and then feeling worse ( agitation - eating compulsively, smoking non-stop, nervousness, antsy all over my body, physical and mental anxiety).For me, it was clear, I didn't tolerate everything regarding serotonine.The funny thing was that 1 week ago, i read about akathisia and serotonergic drugs, that it can appear not on heavy AP's.
So, i did a test: beginning the MOST offending SSRI regarding agitation and so (akathisia maybe) - Celexa, at 5 mg/day, then added:
Propanolol 10 mg bid(beta-blocker)
Akineton 1-2 mg bid(biperiden, anticholinergic)MAN, what a difference!No more agitation, no more compulsive eating and smoking, wow!So far so good, I discovered after so many years that I suffer from a milder form of akathisia which was abolished (for good I hope) by Propanolol and Akineton.
One funny thing is that when I got hit by akathisia-like sensations, I want to go to sleep to get rid of that awful sensations and what I felt from about a week on Celexa (5mg) and Propanolol/Akineton combination, was that i felt relaxed and normally energetic, to wanting to go to sleep.
I just felt normally centered and WANTING to do things.
I read somewhere on askpatient site, somebody told something that for me, now, it makes sense:
"when a ssri/tca works, you just feel ok, not anhedonic, sleepy, agitated"
maybe is something about akathisia-like feelings(which are somatized on a various sensations) on serotonergic drugs on a lot of people who tend to think that their drugs don't work.
Maybe i'm wrong what do you think?
Posted by g_g_g_unit on April 28, 2011, at 2:22:43
In reply to You probably should switch SSRIs, posted by mtdewcmu on April 26, 2011, at 15:04:33
Thanks for the replies, guys. I think the restlessness may have actually had something to do with methylfolate (which I take once a week) potentiating the Zoloft, because it only occurred the day after dosing and has not come back since. I'm still taking 25mg, but have a feeling that the restlessness will return at 50mg which is why I'm hesitant to move up.
I'm also battling with terrible restless legs syndrome, which is wreaking havoc on my sleep. Unfortunately, this has become a feature with me on all ADs, which is why I'm looking at finally having treated. From what I understand, parkinson's agents have some efficacy in treating akathisia(?) so I may be able to kill two birds with one Rx'd stone.
Posted by g_g_g_unit on April 28, 2011, at 2:24:26
In reply to You probably should switch SSRIs, posted by mtdewcmu on April 26, 2011, at 15:04:33
> I experienced restlessness on Zoloft that never went away even after months. It's a shame, because otherwise it seemed like a great drug. I had similar problems with Prozac. I would recommend trying one of the more "sedating" SSRIs, which is basically any SSRI other than Prozac and Zoloft. Celexa seems to be the sweet spot for me. I also tolerated Paxil, but had other nasty side effects.
Yeah, I don't recall experiencing any restlessness on Lexapro or Luvox a couple of years back, though both were far more numbing than Zoloft is so far.
Posted by SLS on April 28, 2011, at 4:48:20
In reply to update, posted by g_g_g_unit on April 28, 2011, at 2:22:43
> Thanks for the replies, guys. I think the restlessness may have actually had something to do with methylfolate (which I take once a week) potentiating the Zoloft, because it only occurred the day after dosing and has not come back since. I'm still taking 25mg, but have a feeling that the restlessness will return at 50mg which is why I'm hesitant to move up.
>
> I'm also battling with terrible restless legs syndrome, which is wreaking havoc on my sleep. Unfortunately, this has become a feature with me on all ADs, which is why I'm looking at finally having treated. From what I understand, parkinson's agents have some efficacy in treating akathisia(?) so I may be able to kill two birds with one Rx'd stone.
Pretty smart!I didn't think Akineton (biperiden) was available anymore. I'm glad to know that it is.
- Scott
Posted by mtdewcmu on April 28, 2011, at 11:45:28
In reply to Re: You probably should switch SSRIs, posted by hopefullynow on April 28, 2011, at 1:13:15
> Propanolol 10 mg bid(beta-blocker)
> Akineton 1-2 mg bid(biperiden, anticholinergic)
>Have you tried them individually? It would be interesting to know what each one is doing and if both are really necessary.
Posted by hopefullynow on April 28, 2011, at 14:36:40
In reply to Re: You probably should switch SSRIs » hopefullynow, posted by mtdewcmu on April 28, 2011, at 11:45:28
No, i haven't tried propanolol and akineton individually but my propanolol intake is fairy low...10 mg, so i assume that the job is mainly done from aki.
Tomorrow, i will try without P. and i'll report back if there are some changes in my mood thru the day.
However, I don't like the feeling that prop. gives me, makes me feel like a jelly, i climb the stairs and have pains in my legs.
Posted by mtdewcmu on April 28, 2011, at 17:26:58
In reply to Re: You probably should switch SSRIs » mtdewcmu, posted by hopefullynow on April 28, 2011, at 14:36:40
> No, i haven't tried propanolol and akineton individually but my propanolol intake is fairy low...10 mg, so i assume that the job is mainly done from aki.
That is a really minute dose. Are you taking it once, or divided up through the day?
>
> Tomorrow, i will try without P. and i'll report back if there are some changes in my mood thru the day.It can be dangerous to stop suddenly, but you probably don't need to taper such a small dose.
>
> However, I don't like the feeling that prop. gives me, makes me feel like a jelly, i climb the stairs and have pains in my legs.I probably could not tolerate it. I am sensitive to orthostatic/postural hypotension. Even a small dose of Abilify (2-5mg) caused me to feel like I was about to faint when standing.
Posted by hopefullynow on April 28, 2011, at 21:13:40
In reply to Re: You probably should switch SSRIs » hopefullynow, posted by mtdewcmu on April 28, 2011, at 17:26:58
Akathisia can be a very serious thing and it seems it can be hidden in a LOT of manifestations.
For me, it could be a sort of anxiety-inner overdrive or agitation.Smoking cigarette after cigarette, disorganization, compulsive eating, or a pseudo social anxiety, I feel overwhelmed in the presence of people.
I can't sleep and paradoxically, after a strong cup or two of espresso I can finally lay down and be calm for some time.For me it was always an alarm signal that after ingesting an stimulating thing my body and my mind finally shuts down for some time.
I thought I am ADHD, but these offending manifestations always appear in the presence of an serotonergic drug.
About propanolol, I take it, in the morning (10 mg) along with Celexa and Akineton.Maybe I should split it in two mini 5 mg doses.
True, I could be also sensitive to orthostatic/postural hypotension that propanolol gives me, maybe that's why I feel so bad when I perform more strenous movements like climbing five floors..
One thing I also noticed is that I became a little puffy, like when I was on anti psychotics on one of my med trials from past.Sounds like an overproduction of prolactine and I don't know what's the offending drug:
Celexa or Akineton?
I tend to blame Celexa, maybe it occupies my dopamine receptors and and therefore the akathisia manifestations appear on SSRI's and TCA's.
> > No, i haven't tried propanolol and akineton individually but my propanolol intake is fairy low...10 mg, so i assume that the job is mainly done from aki.
>
> That is a really minute dose. Are you taking it once, or divided up through the day?
>
> >
> > Tomorrow, i will try without P. and i'll report back if there are some changes in my mood thru the day.
>
> It can be dangerous to stop suddenly, but you probably don't need to taper such a small dose.
>
> >
> > However, I don't like the feeling that prop. gives me, makes me feel like a jelly, i climb the stairs and have pains in my legs.
>
> I probably could not tolerate it. I am sensitive to orthostatic/postural hypotension. Even a small dose of Abilify (2-5mg) caused me to feel like I was about to faint when standing.
Posted by mtdewcmu on April 29, 2011, at 0:08:07
In reply to Re: You probably should switch SSRIs, posted by hopefullynow on April 28, 2011, at 21:13:40
> Akathisia can be a very serious thing and it seems it can be hidden in a LOT of manifestations.
>I'm not sure if it was akathisia, but on Zoloft I felt unbearably restless. I could not stand it.
> About propanolol, I take it, in the morning (10 mg) along with Celexa and Akineton.Maybe I should split it in two mini 5 mg doses.
>Propranolol is meant to be taken 2-4 times a day. So if your akathisia feels better all day, it probably wasn't the propranolol.
Posted by hopefullynow on April 29, 2011, at 0:56:07
In reply to Re: You probably should switch SSRIs » hopefullynow, posted by mtdewcmu on April 29, 2011, at 0:08:07
Yep, it's almost mid day and no propanolol, only Celexa and Akineton and i haven't noticed any difference in increasing in agitation.So far so good, thanks biperidene!
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