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Mental Health (Expert Forum)
Anxiety and Depression
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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Anxiety and Depression
by TOMCOMPLER, Aug 21, 2003 12:00AM
Dear Doctor: Three years ago, in July 2000, I became extreme worried and depressed because I thought I got an incurable and fatal disease. I could not sleep at night. I felt numb and tingling at my toes and sharp pain in various places on my body.
I went to see my personal physician, then an internist, and then
an infectious disease specialist, but no one found any wrong with me.
Finally, I went to see a Psychiatrist who gave me Remeron. He explained to me that my brain's chemicals are out of balance so that I could not sleep and my brain sent out those signals that made me feel tingling, numbness and pain.
Remeron likes a God-send to me because I slept like a baby in the first night I took 30mg tablet. The next day all symptoms disappeared and I felt so good.
One year later, in 2001, I started to cut down the doses from 30mg to 15 mg, then 1/2 of 15mg. The symptoms came right back after about 3 months: sleeplessness, numbness, pain, tingling and very tire in the afternoon. I must retake the whole 30mg again and, again, all problems went away.
Three months ago, I started to cut down the dose to 15mg again. The symptoms came right back. Right now, I am so miserable because I could not sleep, pain in so many places on my body, tingling at my toes and very tire in the afternoon. I must take 10mg Ambian to help me sleep at night.
Doctor, please help me. What do I do now? What is wrong with me?
I re-take Remeron again in the last 10 days but it's not effective yet. Do I have to take Remeron for the rest of my life? It's not worth living if this condition continues. I am forever grateful for your help and advise.
I went to see my personal physician, then an internist, and then
an infectious disease specialist, but no one found any wrong with me.
Finally, I went to see a Psychiatrist who gave me Remeron. He explained to me that my brain's chemicals are out of balance so that I could not sleep and my brain sent out those signals that made me feel tingling, numbness and pain.
Remeron likes a God-send to me because I slept like a baby in the first night I took 30mg tablet. The next day all symptoms disappeared and I felt so good.
One year later, in 2001, I started to cut down the doses from 30mg to 15 mg, then 1/2 of 15mg. The symptoms came right back after about 3 months: sleeplessness, numbness, pain, tingling and very tire in the afternoon. I must retake the whole 30mg again and, again, all problems went away.
Three months ago, I started to cut down the dose to 15mg again. The symptoms came right back. Right now, I am so miserable because I could not sleep, pain in so many places on my body, tingling at my toes and very tire in the afternoon. I must take 10mg Ambian to help me sleep at night.
Doctor, please help me. What do I do now? What is wrong with me?
I re-take Remeron again in the last 10 days but it's not effective yet. Do I have to take Remeron for the rest of my life? It's not worth living if this condition continues. I am forever grateful for your help and advise.
Doctor's Answer
by Roger Gould, M.D., Aug 22, 2003 12:00AM
, Aug 22, 2003 12:00AM
there are many more medications now to help you with your anxiety symptoms so I suggest you visit a psychiatrist who specializes in psychopharmacology and let him help you. You should not have to be on medications all of your life.
I really feel so sorry for you that you cannot kick Remeron after 3 years. I took Fluvoxamine (similar to Remeron) 50 mg and Clonazepam (similar to Ambian) 2mg and mianserin 60mg all at night for 10 years because of depression, anxiety and personality disorder. I had practically no psychotherapy nor support from family and friends (They don’t known about it). Now I can do without Fluvoxamine at all. I dropped Fluvoxamine since 1st of August 2003 without recurrence of social anxiety. For 10 years I have been very cautious in cutting down each of my drugs. I will take the full dose at the earliest signs of depression or anxiety coming back. In this way reducing my drugs and their doses does not affect my work. I know exactly what will happen if I reduce my dose. As I am well maintained for 10 years, I am more confident that can decrease my drugs since I know that my chemistry is stabilized. As I wrote to this forum on the 8th August 2003, I had been without Fluvoxamine for more than a week. As Dr. Roger Gould of this forum told me that it were my unfavorable past life events that conditioned me to respond like a reflex to feel that others are looking down on me and that in reality others are not, my social anxiety is mainly a psychological reflex in action and mechanism. I am therefore more confident to off Fluvoxamine, which served to tide me over for all these years until I gain insight of the mechanism causing my social anxiety. I begin smiling at people and see them smiling back, indicating that they are not regarding me crazy or insignificant or odd. I fear people no more. My social anxiety is gone. Good-bye to Fluvoxamine. I understand that I have to go a long way to gain insight to my depression, general anxiety, and personality disorder and finally do without any drugs. But this is a significant milestone that marks the end of my long history of social anxiety and Fluvoxamine intake - thanks to Dr Roger Gould. I verily believe that your depression will end as your chemistry becomes normal and you understand the psychological mechanism of your depression via psychotherapy your termination of Remeron and Ambien is a matter of time. Therefore be patient but enthusiastic.
Best wishes from Tyr_to_be_social
I went to see my Psychiatrist yesterday. Just as Dr. Gould said, and I found out after much research, my problem is now pinpointed: General Anxiety Disorder. I made myself sick worrying is the bottom line. I thought I knew every thing because I am a very high educated individual. So much for my intelligence and knowledge!!!
Doc gave me 0.5mg Clonazepam. I took twice yesterday at about 4 hours interval. I fell into sleep in about 20 minutes last night WIHTHOUT taking the damn Ambian the first time after more than 2 weeks. This morning I feel much better. I will try NOT to consume more than 1mg daily.
Will you give me some experience with this Clonazepam please. Can you drop it easily withouth withdrawal symptoms? My Doc gave me Klonopin (brand name) but my insurance company made me taking generic instead. Again, thanks for your advise. Hope to hear from you soon. TOM.
I am most glad that you take Dr Gould’s diagnosis of your anxiety symptoms, namely insomnia, tingling, pain, worry and misery and his advice to see your psychiatrist to obtain medication to relieve such symptoms and that your psychiatrist and you make the right diagnosis of general anxiety disorder, which is very often associated with depression and that you are given the right anxietiolytic, i.e. clonazepam.
I admire your determination to take enthusiastic variety of ways and steps to defeat your GAD and depression.
It is great that you have insight that it is your excessive worrying that makes you sick and that you understand your strengths of being intelligent, very highly educated and knowledgeable. And such strength enables you to realize, in fact, that irrational worrying is making you ill. You are able to stop the irrationality and uselessness of worrying and face the constructive reality of your strengths. Therefore you are well maintained now with a small dose of Klonopin.
Yes, I have taken clonazepam 2mg for GAD and Mianserin (antidepressant) 60 mg for depression) for 10 years. I am still off Fluvoxamine (a SSRI antidepressant) for social phobia. I have never go beyond 2mg of clonazepam, meaning that I am not abusing it. I have tried 0.5 mg off occasionally without general anxiety problem. If I were not weaning Fluvoxamine at the moment, I will definitely try to cut down on my clonazepam very slowly at the rate of 0.25mg or less. You can split your clonazepam 0.5 mg into 4 quarters, each of which is 0.125mg. Mind you Ambian is for pure insomnia and is less addictive while clonazepam is for anxiety and/or insomnia and is addictive. Clonazepam is not habit-forming if taken for less than 1 to 2 months. As you are just starting clonazepam and if you are undergoing psychotherapy, your GAD will probably go away in less than 2 months and you will be able be tail down your clonazepam quite rapidly. The withdrawal symptoms of clonazepam less than 1 mg a day will be nil to minimal nervousness. Of course, I cannot exclude mild sleeplessness, slight aches and minor tingling as other withdrawal effects. The withdrawal symptoms vary in different individual but they are most likely to be similar to what you experience before the clonazepam. For me they are just nervousness and insomnia.
I would not worry at all taking generic clonazepam because you are well even on a kind of clonazepam which is equivalent or slightly weaker than Klonopin.
Wish you psychologically-minded,
From Try_to_be_social
DAVE