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Mental Health (Expert Forum)
Increased Anxiety
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.
Increased Anxiety
by roger7, Feb 09, 2004 12:00AM
I have been taking Paxil (30 mg) for nearly three years for panic attacks, anticipatory anxiety, and insomnia. I have always responded really well to Paxil - within 4 days of taking it, I felt like myself again, with no sleep issues (after living through 4 months of insomnia and axiety). I am currently pregnant and decided to switch to Zoloft due to potential withdrawl effects for the baby with Paxil. I started Zoloft at 25 mg, continued Paxil at 30 mg. for one week, and had no problems. At the beginning of week two of the transition, I decreased Paxil to 20 mg. and increased Zoloft to 50 mg. I continued this for 3 days before experiencing intense insomnia, stomach aches, diarreha, and an increased feeling of anxiety. I immediately discontinued the Zoloft and increased my Paxil to 30 mg. again. Since (it's now been 9 days without Zoloft), I have been experiencing continued sleep issues, lack of appetite (I've lost 10 pounds), on and off diarreha, and extreme anxiety, especially anticipatory anxiety regarding sleep. These issues have resulted in depression and an overall lack of confidence in the Paxil (which I have always responded to very well). I should mention that in the past I have tried to discontinue Paxil use, but have experienced a relapse of anxiety/panic/insomnia symptoms which required me to continue Paxil at my normal dosage. It usually takes a week or two to restablize on the Paxil (my last attempt to discontinue, I was down to 10 mg./day and had been there for several weeks). I'm trying hard to understand what may be happening now. At first, I strictly thought it was the Zoloft and assumed that after it was out of my system, I would return to "normal" (I was told that the Zoloft would take approx. 6 days to leave my system). As mentioned previously, it has been 9 days since Zoloft discontinuation and I'm continuing to experience symptoms as if I was not on medication at all. I'm wondering if I should speak to my doctor regarding an increase in Paxil? Or, should I wait longer for my body to restablize? Please advise.
Doctor's Answer
by Roger Gould, M.D., Feb 09, 2004 12:00AM
, Feb 09, 2004 12:00AM
I think your loss of confidence in Paxil and your fear of being without it( the paradox) is the source of your symptoms so changing the dose probably is not the best thing to do. YOu have underlying anxiety and have been reliant on medications and want to get off, so why don't you get some short term therapy in order to deal with your fears and dependency on the medication. It will probably be better for you and the baby. It is worth a good try.
I was diagnosed with panic/anxiety in 1999. I use Ativan 0.5 mg for acute attacks, otherwise no medications. I became pregnant in 2003. Almost immediately, I noticed an increase in my anxiety symptoms. I've read extensively about correlations between certain hormones and symptoms of anxiety. Additionally, anxiety is common among many new mothers-to-be anyway.
I found that prenatal yoga and other pregnancy-approved mild exercises helped ease my symptoms a LOT. Also, beware of drops in blood sugar while you're pregnant...your need for glucose increases and drops in blood sugar can trigger symptoms that are very panic attack-like.
I researched SSRIs extensively during my pregnancy, weighing the risks versus benefits of such a drug in place of my Ativan. I opted to stick with the Ativan, but I haven't ever heard of Paxil withdrawal in infants. In fact, I've heard of more clinically significant side effects from Zoloft (in adults), which would lead me to believe that your original medication was not a bad one. SSRI medications are generally believed to be safe during pregnancies. Besides, the anxiety's adverse effects may be worse for you and baby both than the Paxil.
Finally, consider "placebo effect". When I was initially diagnosed with panic/anxiety, I took the Ativan twice daily. If I forgot a dose, I'd usually be just fine until I remembered that I'd forgotten...at which point I'd immediately begin feeling anxious. If you believe that the Zoloft isn't working...it may be a mind over matter issue.
I hope this helps! I know how frustrating it can be.