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Mental Health (Expert Forum)
Anxiety / Severe 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.
Anxiety / Severe Depression
by Daniel2187, May 21, 2005 12:00AM
Hi. I've had some major concerns lately, about my mental well-being. I am in the beginning process of seeking help for myself now. An explanation is in order:
I am a 20-year-old male, and have been a casual drug user for a few years, mainly using cocaine, marijuana, and hard liquor (casual, meaning on the weekends). Marijuana and alcohol I've been using since H.S., but only in the last 8 months I started using cocaine. About 2 months ago, I had a pretty horrible "episode" in which I mixed excessive amounts of these three substances (which I had only done once before). Even now, I'm not really sure what this "episode" was. It continued at the same intensity for about 5 hours, so I know it wasn't just a "panic attack". I hadn't experienced anything remotely like it and was very convinced that I was going to die. The symptoms were very much like a panic attack though: (heart weakness, chest pain, lightheadedness, tingling sensations, shaking, difficulty breathing, a strong sense of impending doom, etc.) and to make a long story short, I did not go to the ER and the symptoms finally wore off. Thankfully, the outrageous, petrifying fear of overdosing and dying has caused me to stop ALL drug and alcohol use indefinitely, likely for good. I can confidently say that I have no desire for them anymore.
Well, since that day, I have had "panic attacks" similar to that night, except now they only last 15-30 minutes. Prior to this first night, I had never experienced any panic attacks, anxiety, or depression before, so I am convinced that everything afterwards was a direct result of that first "episode". After meeting with my doctor, he prescribed me Xanax XR (5 days ago) which I have been using since. Although it does "work", I've recently developed a quite severe depression, for no apparent reason. I have been practically unable to eat solid food, and I often feel like committing suicide without knowing why. After much thought and consultation with my family (who are convinced I'm on the "wrong" medication) I have decided to talk with my doctor this week about antidepressants such as Zoloft, Prozac, Celexa, etc. The Xanax XR is not likely responsible for this sudden depression, but I am convinced that it is NOT helping, and my depression requires quick help. I've also consulted with my mother, who's been on Xanax XR daily for the past 6 months. She hates it, and is now "hooked" and can't function without it. My questions:
1) Should I switch from Xanax XR to another form of medication, such as an SSRI/antidepressant? If so, which one(s)?
2) What type of therapy should I seek along w/ my medication?
3) Can I experience a heart attack resulting from my past cocaine use, even though I've stopped permanently?
4) Has there likely been a permanent physical/chemical change in my body, from the drug use, which has caused these severe anxiety/depression symptoms? If so, can I eventually overcome them through proper medication and therapy?
Thanks!
I am a 20-year-old male, and have been a casual drug user for a few years, mainly using cocaine, marijuana, and hard liquor (casual, meaning on the weekends). Marijuana and alcohol I've been using since H.S., but only in the last 8 months I started using cocaine. About 2 months ago, I had a pretty horrible "episode" in which I mixed excessive amounts of these three substances (which I had only done once before). Even now, I'm not really sure what this "episode" was. It continued at the same intensity for about 5 hours, so I know it wasn't just a "panic attack". I hadn't experienced anything remotely like it and was very convinced that I was going to die. The symptoms were very much like a panic attack though: (heart weakness, chest pain, lightheadedness, tingling sensations, shaking, difficulty breathing, a strong sense of impending doom, etc.) and to make a long story short, I did not go to the ER and the symptoms finally wore off. Thankfully, the outrageous, petrifying fear of overdosing and dying has caused me to stop ALL drug and alcohol use indefinitely, likely for good. I can confidently say that I have no desire for them anymore.
Well, since that day, I have had "panic attacks" similar to that night, except now they only last 15-30 minutes. Prior to this first night, I had never experienced any panic attacks, anxiety, or depression before, so I am convinced that everything afterwards was a direct result of that first "episode". After meeting with my doctor, he prescribed me Xanax XR (5 days ago) which I have been using since. Although it does "work", I've recently developed a quite severe depression, for no apparent reason. I have been practically unable to eat solid food, and I often feel like committing suicide without knowing why. After much thought and consultation with my family (who are convinced I'm on the "wrong" medication) I have decided to talk with my doctor this week about antidepressants such as Zoloft, Prozac, Celexa, etc. The Xanax XR is not likely responsible for this sudden depression, but I am convinced that it is NOT helping, and my depression requires quick help. I've also consulted with my mother, who's been on Xanax XR daily for the past 6 months. She hates it, and is now "hooked" and can't function without it. My questions:
1) Should I switch from Xanax XR to another form of medication, such as an SSRI/antidepressant? If so, which one(s)?
2) What type of therapy should I seek along w/ my medication?
3) Can I experience a heart attack resulting from my past cocaine use, even though I've stopped permanently?
4) Has there likely been a permanent physical/chemical change in my body, from the drug use, which has caused these severe anxiety/depression symptoms? If so, can I eventually overcome them through proper medication and therapy?
Thanks!
Doctor's Answer
by Roger Gould, M.D., May 23, 2005 12:00AM
, May 23, 2005 12:00AM
no to the heart attack question...won't happen. no permanent physical damage.
but,
these flash backs to the trauma you did to yourself with these medications are likely to be around for a while longer, on and off, so don't be suprised or too worried about them.
Yes, xanax can deepen a depression. Even though it is short acting, it has a hang over effect, and decreases your motivation, which heightens your depression. I would suggest talking to your doctor about any of the ssri's you mentioned...they are all roughly the same and act slightly differently from person to person so its hard to say which will be best for you.....so, start with slow dose, think about cutting out the xanax, and if you can find a good talk therapist, that is your best bet for treatment that will be lasting. r.g.
but,
these flash backs to the trauma you did to yourself with these medications are likely to be around for a while longer, on and off, so don't be suprised or too worried about them.
Yes, xanax can deepen a depression. Even though it is short acting, it has a hang over effect, and decreases your motivation, which heightens your depression. I would suggest talking to your doctor about any of the ssri's you mentioned...they are all roughly the same and act slightly differently from person to person so its hard to say which will be best for you.....so, start with slow dose, think about cutting out the xanax, and if you can find a good talk therapist, that is your best bet for treatment that will be lasting. r.g.
This is very common, to become depressed after using these strong substances which you have used. Usually this type of depression you are experiencing has no definite cause ie. you may be sitting in the lounge, on the bed or on the tennis court and you will experience thoughts of suicide, why am I alive?etc.
You will get through this. The drugs which you have taken have affected some of the chemicals in your brain which affect your mood, thinking and feelings on life. This may take a while for the effects to wear off, sometimes years.
Daniel, you are in it for the long haul, but guess what? You will get through it. The fact that you have stopped taking these substances shows that you want to live life and get high on it rather than drugs.
Write to me on ***@**** and we will chat more about this.
I am not as persuaded as the doctor is that therapy does much for depression. I'm a much bigger fan of medication, though I know that some people fear it, worry about becoming addicted to it, and worry about not being able to stop. A really good doc, though, will monitor your medications, will prescribe them in relatively small increments (several months, say, as opposed to a whole year) so that he or she can check in with you frequently, and will help you determine when a change is in order, and how or whether to taper off.
Cocaine is hugely addictive. Please do keep in mind that at least some of your depression is likely in response to coming down off that high.
Best,
marriedlove
I think that drugs put a stress on our systems, and I don't just mean cocaine type drugs. I was put on Sarafem, which is a Prozac look alike, and it caused severe incontinence. Then I read the insert, and the insert warned that it shouldn't be used with certain kinds of blood problems, which I think pernicious anemia type problems are.
But pernicious anemia is very rare, while B12 malabsorption and
hypochlorhydria (not enough gastric acid) are quite common. Especially the not-enough-gastric-acid thing, because of how many antacids people use.
So, I think that a lot of drugs are counterindicated, only we aren't fully aware of what they do and what our underlying problems are, so we take them and they stress our systems. Maybe not enough to have severe incontinence, but enough to cause harm over a period of time.
I think we all pretty much agree that cocaine and drugs like that can be harmful, but I think it's less well recognized that "good" drugs can be stressful, too.
Bottom line: if you have any other symptoms of low B12 besides depression (I forgot to say that once I got B12 replacement, my depression went away) then I think you might be very pleased with the results from taking B12.
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I think that drugs put a stress on our systems, and I don't just mean cocaine type drugs. I was put on Sarafem, which is a Prozac look alike, and it caused severe incontinence. Then I read the insert, and the insert warned that it shouldn't be used with certain kinds of blood