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Dr. Bob is Robert Hsiung, MD,
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Posted by scleme1 on April 21, 2014, at 10:32:59
40 year-old male. On Paxil 40mg for approx. 12 years. Switched to Sertraline 200mg about 2 year ago. Anxiety and OCD diagnosis.
I've been getting an inner nerves/restlessness/butterflies feeling most every night at bedtime. It feels like energy is building up inside me and I have to flip over in bed to ease the feeling, then it starts building again and the whole process begins again, over and over, until I finally fall asleep. I typically read/play games on my iphone before falling asleep. I can feel the inner tension building as I am playing on my iphone, until I'm forced to put it away and begin moving around to try and alleviate the feeling.
It's hard to describe. It's more a physical feeling as opposed to a mental anguish. It's not intolerable.Yet. However, I'm starting to feel the tension slowly creeping in during the day.
The feeling comes and goes. It doesn't happen every night, and mostly happens when I think about it/start worrying about it. Same thing happened several months ago adn it seemed to work itself out...only to return again recently. I've tried taking a small dose of Propranolol, but it doesn't help. At all.
I have several questions for the pros here on babble. Do you guys think this is Akathisia? Do you think it's being caused by Zoloft? What should I do about it? I really like my Zoloft, so is there any risks with taking something to help with the feeling and stay on the Zoloft? I don't want this to be permanent (of course), so I will change meds if I have to, but would prefer not to change.
Thanks so much for any dvice/help you can give!
Posted by phidippus on April 21, 2014, at 12:35:53
In reply to Zoloft + Akathisia? Not sure what's going on..., posted by scleme1 on April 21, 2014, at 10:32:59
>Do you guys think this is Akathisia?
No, this is not akathisia. It is anxiety-I have experienced it many times myself.
>Do you think it's being caused by Zoloft?
The zoloft may not be treating this leftover bit of anxiety your experiencing. Try raising the dose and see what happens. If it gets worse, it is indeed the Zoloft.
>What should I do about it?
You can also try some ativan or whatever benzo you have handy and see if it suppresses the feeling.
>is there any risks with taking something to help with the feeling and stay on the Zoloft?
A benzo won't be a risk at all.
Eric
Posted by Christ_empowered on April 21, 2014, at 20:15:24
In reply to Zoloft + Akathisia? Not sure what's going on..., posted by scleme1 on April 21, 2014, at 10:32:59
hey. I hope things get better soon. I just wanted to add that you have a few non-benzo options...I was thinking lyrica or Neurontin.
Posted by scleme1 on April 21, 2014, at 20:38:17
In reply to Re: Zoloft + Akathisia? Not sure what's going on..., posted by Christ_empowered on April 21, 2014, at 20:15:24
Thanks for the feedback guys. I would like to go the non-benzo route. I took klonopin every evening years ago. I love the stuff. Couldn't wait til 10:00 every evening so I could pop a couple. Quitting was horrendous. Won't do that again unless I have to. I'm hoping this works itself out. I'm considering benadryl tonight just to see what happens. Time will tell.
Posted by LostBoyinNC45 on April 22, 2014, at 22:59:09
In reply to Zoloft + Akathisia? Not sure what's going on..., posted by scleme1 on April 21, 2014, at 10:32:59
I was formally diagnosed with SSRI induced akathisthia way back in 1998, in the very early days of my depression. I got it from the SSRI zoloft and also from paxil. I get it from all the SSRIs.
A bigshot Neuropsychiatrist from Duke dxed me with SSRI akathisthia and it is a formal part of my psychiatric records.
Here were the symptoms I would get:
Id take zoloft or paxil and it would be real bad for the first few weeks. It was a muscle thing heavily, but also an internal anxiety or agitation type feeling that was drug induced. It would cause me to move my legs around a lot while laying in bed or sitting in a chair, gave me the urge to walk a lot, made my muscles stiff feeling (especially legs), made me generally nervous feeling whereas before the SSRI my complaint was mainly severe fatigue and severe depression type symptoms.
For me, the akathisia would go away after a few weeks, after my system had adjusted to the dose of SSRI. If I increased the dose of SSRI later on, I'd get a new flareup of akathisia for a week or so and it would calm down.
Now in middle age, I know when my threshhold for SSRIs hits. My legs will get stiff while walking. If I decrease the SSRI dosage, the leg stiffness goes away completely.
When I was originally diagnosed with SSRI akathisia, I was told by the psychiatrist who diagnosed it to take 50 mg OTC benadryl daily. That the benadryl is a mild anti-cholinergic and helps to "smooth out" the SSRI akathisthia side effects. I found that to be true and benadryl did help a lot. Also, benzos like klonopin will help calm down akathisia.
the only anti-depressant I ever took that did not cause akathisia is Remeron. ZERO akathisia with Remeon. Also, rTMS did not ever cause any akathisia. The MAOI Parnate caused minimal akathisia but did cause an initial "activation" feeling for a few weeks that was stimulating and uncomfortable, but when my body adjusted it went away completely. Never got any need to move my legs or pace or move around on MAOI parnate.
Also, in my experience a lot of psychiatrists dont seem to have much experience or understanding of psychiatric drug induced movement disorders. Yeah, they can and will recognize full blown TD but Ive heard of many, many cases of akathisia that was misdiagnosed as a flareup of anxiety or panic or even a development of psychosis by poorly trained psychiatric social workers and psychologists. They just dont know psych drugs well.
Eric AKA "LostBoyinNC"
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