Anxiety and depression

[cade]

Dear Dr,
Some background information first. I am 39 years old, I am a wheelchair user (paraplegic), this means I am completely paralyzed from the waist downwards. I suffer from constant pain and chronic spasms in my legs caused by my disability and all the other things that you can imagine that go with this type of disability. My disability was caused by being run over by a truck 17 years ago.
I have never suffered from anxiety or depression before, I have felt "down or low " but never depressed or anxious before.
About 3 months ago I started getting all the text book symptoms of General Anxiety disorder., feeling anxious, trembling, increased heart rate, generally feeling frightened all the time. I relay on my family for help and support. My mum and dad are getting older and are not in the best of health which doesn’t help as you can imagine. I live on my own which obviously adds to my distress.
My Dr is very supportive which is worth its weight in gold, He is quite surprised that I have managed to go own for so long without having problems.
I am trying to keep busy, getting out of the house as much as I can etc.
I have been prescribed Propranolol 40mg (Beta - Blockers) to keep my heart rate down, which was about 110 beats per minute when I am sat on the couch reading a book!. I don’t get on with SSRI’s, so my Dr prescribed  Prothiaden (dothiepin) to help me relax at night and to help with sleep as well as my depression .
Could anyone let me know if Prothiaden (dothiepin) is a good anti-depressant to take for my condition, and do you think this will increase my spasms, as the SSRI’s tend to make me feel like  I am vibrating and they increase my spasms drastically.
I would appreciate any feedback as I am feeling so lost and confused as all this has come as a massive shock to me. Add this on top of my disability and the worry I have for my family’s health and you can imagine how this is making me feel .
Any response and support will be gratefully Accepted
Thanks for your help Mark

[Roger Gould, M.D.]

This is generally considered to be a good and useful medication, and there is no mention of side effects like increased spasm. There is a possible side effect of increased heart rate, so you have to watch that closely and sort out the consequences of taking this medication.  If heart rate is because of anxiety, and this helps anxiety, the heart rate should come down, and you should be able to get off of the beta blocker.  It takes about 3 weeks for full effect.

[Try_to_be_social]

You are indeed a strong person, given your kind of adversities. I think your dr is marvelous. It is wise to switch from SSRI to another class of antidepressant such as Prothiaden. In the pre-SSRI era, Prothiaden is one of the best and most popular antidepressant. Prothiaden is a tricyclic antidepressant and is indicated for anxiety, depression and insomnia. It side effect profile is quite different to that of SSRI as it blocks the reuptake of norepinephrine instead of serotonin, so, don’t worry. Its maximum therapeutic dose is 150 mg. It is not suitable for people with severe heart problem. You have no heart problem because your heart is racing only in time of stress/anxiety. CBT is highly recommended for you. Please see post dated 16NOV at <a  href=http://www.medhelp.org/perl6/MentalHealth/messages/C32374-5.html>;http://www.medhelp.org/perl6/MentalHealth/messages/C32374-5.html<;/a> and message dated 20OCT and 26OCT at <a href=http://www.medhelp.org/perl6/MentalHealth/messages/C32351-11.html>;http://www.medhelp.org/perl6/MentalHealth/messages/C32351-11.html<;/a>.