SSRI Paradoxical Effect After 3 Doses?

[joebot]

I started having panic attacks/anxiety around a month ago after going 20 years without (I'm 47).  My doctor (primary) put me on Citalopram (Celexa), and after 3 days I had to stop after suffering every side effect including horrible insomnia.  It's been over 2 weeks since stopping the drug, and I still have insomnia.  In fact, I feel like I've lost the ability to sleep.  My body is tired, but I just can't transition to sleep.  But I must fall asleep at some point, because I'll remember a dream.  I took a nap today and it felt like my body was asleep but my brain was quite active.  Yesterday I felt the closest I did to feeling normal, and I was confident that my sleep would be better last night, but it was worse.  My sleep was much, much better before the Citalopram.  I'm in the process of seeking therapy, but according to intake personnel it could take a month.  I don't know how much longer I can put up with this.  I'm wondering if I'm experiencing the "paradoxical effect" of SSRI's, where serotonin in the brain is decreased instead of increased.  Apparently that messes up your whole system, and may be irreversible.  I mean, I've never been the most optimistic person even before the panic, but I have sunk to the very bottom of the well.

[joebot]

Thank you so much for the information and your prayers.  They are much appreciated.

[RabidSquirrel5]

Joe, if you are still around, I have been suffering similarly for the past 8 months.  Did you ever find relief?

[mklarson]

Your problem is two fold. First it is important to get your sleep under control as it is necessary for your anxiety reduction long term. Second, controlling your anxiety so you can sleep. Sound like a paradox? Anyway, here are a couple of suggestions to talk with your doctor about: First, the possible addition of Zanaflex (between 2 to 8mg) at bedtime to help you sleep. I found that many patients with high anxiety benefited from this safe muscle relaxer. Second, the slow low-dose introduction of Gabatril for refractory anxiety.  Dosing starts at 2mg and increases by 2mg increments every month to a target dose of 4 to 8mg a day. This medicine was originally made for seizure disorders but doctors found that they could use it in lower doses to treat anxiety where the traditional medicines had failed due to side effects or efficacy.

Please stick with the therapy you mentioned as you will find it helpful. Also, if it is group therapy, you will be shocked at the large number of people that are suffering from severe depression and anxiety in the general population. That is good to know, as sometimes it feels like you are all alone in your fight. As you can see from just the posts on this website you are not alone.  

My prayers go with you!

[joebot]

Thank you for your response.  I should have mentioned that I do have an Rx for Lunesta 3mg.  A friend of mine initially gave me two 2 mg. tablets.  I was only able to sleep about 4 hours or so, but it's better than nothing.  The problem is that when I awake I have severe anxiety that lasts throughout the day.  I asked my GP for 3 mg. in hopes of sleeping longer.  I did that for one night, and indeed slept longer, but ended up with depression and suicide ideation as the day went on.  What is so traumatic for me is that before my panic/anxiety resurfaced I was a runner and health freak for 10 years.  I'm still able to get out and run, but my mood is blunted from not sleeping . . . it takes a lot of effort.  I'm also trying light therapy.  I have this persisting fear that my insomnia is now irreversible.  Maybe I've graduated to being a hypochondriac.  Thanks again for the response

[mklarson]

Hi Joe,

  Roughly, 5% of patients starting SSRI's will have a paradoxical presentation during the first two weeks of treatment. Sleep disturbances fall under this heading and can be quite a problem for some. Standard rule of thumb is to treat these patients with a sleep aid for a few weeks to reset their sleep cycle. Examples of this would be Ambien (Zolpidem) or Lunesta (Eszopiclone). Over the counter remedies typically do not work as they are too weak to reset your clock.

I would ask your doctor for an Rx of one of these sleep aids to get you through till therapy. The longer your sleep is disrupted the worse your anxiety can potentially become.

Best of luck.