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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by g_g_g_unit on December 11, 2011, at 6:13:27
i'm rocking back and forth, repeatedly punching my legs, pacing, writhing, valium does nothing ... oh joy
Posted by ed_uk2010 on December 11, 2011, at 8:01:33
In reply to increased lexapro, akathisia ensues, posted by g_g_g_unit on December 11, 2011, at 6:13:27
> i'm rocking back and forth, repeatedly punching my legs, pacing, writhing, valium does nothing ... oh joy
What dose have you increased Lexapro to? Just increased today? What was your previous dose, any restlessness on that dose?
Apart from Valium, what else are you taking?
Posted by gadchik on December 11, 2011, at 8:07:27
In reply to increased lexapro, akathisia ensues, posted by g_g_g_unit on December 11, 2011, at 6:13:27
it took remeron combined w/klonopin to stop that rocking about,and bugs crawling up legs feeling for me.
Posted by creepy on December 11, 2011, at 8:24:56
In reply to increased lexapro, akathisia ensues, posted by g_g_g_unit on December 11, 2011, at 6:13:27
I had this too. But its much worse on zoloft for me. So much for these SSRIs not affecting dopamine! My doc thinks Im crazy when I say things like that.
Benadryl in a pinch.. otherwise ask about adding wellbutrin or a dopamine agonist.
Could even experiment a little and try some supplements like tyrosine and l-dopa.
Posted by ed_uk2010 on December 11, 2011, at 8:31:58
In reply to increased lexapro, akathisia ensues, posted by g_g_g_unit on December 11, 2011, at 6:13:27
> i'm rocking back and forth, repeatedly punching my legs, pacing, writhing, valium does nothing ... oh joy
OK well...
Contact your pdoc.
Take an extra dose of diazepam.
Stop Lexapro, only to be restarted at a reduced dose once akathisia has completely disappeared. Under your doctor's advice, you could then either taper off Lexapro or maintain treatment at a low dose.
A 25mg dose of diphenhydramine is sometimes useful in acute akathisia. It is available in certain OTC antihistamines and sleep aids. Avoid all of the combination 'cold/flu products' because some contain dextromethorpan which interacts with SSRIs. Read the package insert before taking because there are some people who can't take diphenhydramine.
You will feel better really soon, although it may feel like forever.
Posted by Phillipa on December 11, 2011, at 10:24:07
In reply to Re: increased lexapro, akathisia ensues, posted by ed_uk2010 on December 11, 2011, at 8:31:58
Agree about the valium. lexapro causes akathesia. Is this a paradoxical reaction? Phillipa
Posted by Phillipa on December 11, 2011, at 10:34:00
In reply to Re: increased lexapro, akathisia ensues, posted by Phillipa on December 11, 2011, at 10:24:07
Did a quick search and found that propanolol can also help didn't know SSRI's could cause this. Phillipa
Posted by Phidippus on December 11, 2011, at 19:15:09
In reply to increased lexapro, akathisia ensues, posted by g_g_g_unit on December 11, 2011, at 6:13:27
SSRI induced akathisia is usually short lived. Are you sure its not your thoughts causing you agitation.
A simple solution would be to have your doctor call you in some propanalol.
Eric
Posted by g_g_g_unit on December 12, 2011, at 5:11:08
In reply to Re: increased lexapro, akathisia ensues, posted by ed_uk2010 on December 11, 2011, at 8:01:33
> What dose have you increased Lexapro to?20mg
>Just increased today?
About a week ago.
>What was your previous dose, any restlessness on >that dose?
It's hard to say. I have ADHD as well and live in a highly distracting household - dogs, younger brothers, video games - so often I just go with the restlessness and don't really notice it. If you had to ask me at gunpoint, I'd say, yes, I've generally been more restless on Lexapro but I experience that reaction to a lot of medication.
> Apart from Valium, what else are you taking?I use nicotine periodically to concentrate. I worked out yesterday's episode was actually triggered by the nicotine withdrawal. SSRIs seem to lower my akathisia threshold such that withdrawal from dopaminergic agents becomes rather unpleasant.
Posted by g_g_g_unit on December 12, 2011, at 5:16:04
In reply to Re: increased lexapro, akathisia ensues, posted by ed_uk2010 on December 11, 2011, at 8:31:58
Sorry for the late reply, Ed. I posted right before bed time. I did take an extra valium dose along with an OTC anti-histamine, which fixed me up nicely.
Today, I'm still noticing a lot of stuff like muscle clenching, toe-curling, leg jiggling etc., though it's not nearly as bad as during the nicotine withdrawal. I also feel anxious and agitated, though could that just be due to the recent Lexapro dose increase?
My suspicion is that a lot of the EPS/akathisia stuff is lurking under the surface but that the valium is partially masking it. This (20mg) is the highest SSRI dose I've been on, though I'm not sure how that compares to the 75mg of Clomipramine I trialled last year which was really nasty as far as EPS and akathisia went.
> OK well...
>
> Contact your pdoc.
>
> Take an extra dose of diazepam.
>
> Stop Lexapro, only to be restarted at a reduced dose once akathisia has completely disappeared. Under your doctor's advice, you could then either taper off Lexapro or maintain treatment at a low dose.
>
> A 25mg dose of diphenhydramine is sometimes useful in acute akathisia. It is available in certain OTC antihistamines and sleep aids. Avoid all of the combination 'cold/flu products' because some contain dextromethorpan which interacts with SSRIs. Read the package insert before taking because there are some people who can't take diphenhydramine.
>
> You will feel better really soon, although it may feel like forever.
Posted by g_g_g_unit on December 12, 2011, at 5:17:11
In reply to Re: increased lexapro, akathisia ensues » g_g_g_unit, posted by Phidippus on December 11, 2011, at 19:15:09
> SSRI induced akathisia is usually short lived.
Do you mean short-lived with each dose increase, or since the drug is initially instated?
Posted by g_g_g_unit on December 12, 2011, at 5:17:55
In reply to Re: increased lexapro, akathisia ensues, posted by creepy on December 11, 2011, at 8:24:56
> I had this too. But its much worse on zoloft for me. So much for these SSRIs not affecting dopamine! My doc thinks Im crazy when I say things like that.
> Benadryl in a pinch.. otherwise ask about adding wellbutrin or a dopamine agonist.
> Could even experiment a little and try some supplements like tyrosine and l-dopa.Dexamphetamine works a charm, but unfortunately I ran out :(
Posted by ed_uk2010 on December 12, 2011, at 14:18:19
In reply to Re: increased lexapro, akathisia ensues » ed_uk2010, posted by g_g_g_unit on December 12, 2011, at 5:11:08
If I were you, I'd miss one day of Lexapro to reduce your blood level and then re-start at 10mg/day. You can then discuss what to do with your doctor.
Posted by Phidippus on December 13, 2011, at 16:55:37
In reply to Re: increased lexapro, akathisia ensues, posted by ed_uk2010 on December 12, 2011, at 14:18:19
He would be backtracking if he reduced his dose. He needs to get through the akathisia. Propanalol is a good option.
Eric
Posted by Phidippus on December 13, 2011, at 17:45:22
In reply to Re: increased lexapro, akathisia ensues » Phidippus, posted by g_g_g_unit on December 12, 2011, at 5:17:11
>Do you mean short-lived with each dose increase, >or since the drug is initially instated?
It can be short lived with each dosage increase. In fact, the more you move up, the less likely you are to experience it.
This pattern of SSRI induced akathisia occured when I started Luvox. Every 100 mg I increased I had an episode of akathisia that lasted a couple of weeks, then dissipated.
Have you considered propanalol?
Eric
Posted by ed_uk2010 on December 15, 2011, at 15:45:21
In reply to Re: increased lexapro, akathisia ensues » creepy, posted by g_g_g_unit on December 12, 2011, at 5:17:55
So ggg, how are you doing?
Posted by g_g_g_unit on December 16, 2011, at 5:52:27
In reply to Re: increased lexapro, akathisia ensues » g_g_g_unit, posted by Phidippus on December 13, 2011, at 17:45:22
> It can be short lived with each dosage increase. In fact, the more you move up, the less likely you are to experience it.I wish I'd known that when first starting SSRIs. Even my current psychiatrist - who comes highly-regarded - seemed unaware when I said that I'd been told (by my good friend Phiddipus) that it may pass.
>
> This pattern of SSRI induced akathisia occured when I started Luvox. Every 100 mg I increased I had an episode of akathisia that lasted a couple of weeks, then dissipated.Have you ever experienced Parkinsonian-like movements - toe-curling, muscle-rigidity etc.?
>
> Have you considered propanalol?No, the valium's doing an okay enough job of keeping it in check.
Posted by g_g_g_unit on December 16, 2011, at 5:54:19
In reply to Re: increased lexapro, akathisia ensues » g_g_g_unit, posted by ed_uk2010 on December 15, 2011, at 15:45:21
> So ggg, how are you doing?
>
>Okay, thanks for asking. Still experiencing a massive increase in anxiety on this new Lexapro dose, though for some reason it's also left me feeling far more joyful and motivated. I expect all that will die down when the anxiety does too.
Posted by Phidippus on December 16, 2011, at 17:57:32
In reply to Re: increased lexapro, akathisia ensues » Phidippus, posted by g_g_g_unit on December 16, 2011, at 5:52:27
>Have you ever experienced Parkinsonian-like >movements - toe-curling, muscle-rigidity etc.?
SSRI induced akathisia has only caused me extreme restlessness.
HOWEVER, Seroquel brought on full dystonia where my body jerked in uncontrollable movements.
Glad the valium's working for the akathisia. If it persists I really do recommend propanalol.
Eric
Posted by Phidippus on December 16, 2011, at 17:58:26
In reply to Re: increased lexapro, akathisia ensues » ed_uk2010, posted by g_g_g_unit on December 16, 2011, at 5:54:19
The joyfulness and increased motivation are good signs.
Eric
This is the end of the thread.
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