Which SSRI or SNRI for my problems??

[notahypo]

Hi Dolfnlvr,  and anyone in this forum that could shed some light on an answer,

It's NotaHypo again,

Listen I see you mention you are having success with "prozac"? I was under the impression that prozac also had a stmulant effect, which worries me, like effexor did, even though I know one is an SSRI and the other is an SNRI. I am on the fence after being a guinea pig to so many of these types of "antidepressants" with trying "daily prozac" OR Clexea . I am wondering though after "carefully" reading the side -effects profiles of these two I haven't tried and whether they will help me with my GAD and at the same time NOT aggravate or precipitate my PVC's "too much" as some of the others seem to have. I know your no doctor or do you profess to be one but you sound very intelligent and like you learned, as I did, through trial and error, which drugs worked for you? I am curious. I take Temromin 2-3x day ONLY a half of 25 mg tablet each time. It seems to keep my PSVT in check as well as the Tachycardia I very rarely get these days. I also take Klonopin .05mg 1 to 2x a  day depending how I feel.  I must say I did notice a reuction in my anxiety with cybalta at 20mg. a day but I couldn't sleep, and had severe constipation, which I always Had anyway.That is insomnia & constipation. I was fatigued as well. The tenormin alone does that. So that was the only reason I stopped the cymbalta, which has an off-label use for anxiety. That is when I tried effexor Er and ONLY 37.5 mg and had runs of PVC's all night and even had bouts of bigeminy and Trigeminy. I truly think is was the effexor. The doctor tried me on Prestiq as I told you and When I learned that was molecularly the same as effexor after calling Wyeth, the drug company, I suddenly stopped, as I was worried that that would also bring back the uncomfortable runs of Trigeminy and Bigeminy, as well. Also, I felt anxious and nervous after taking the effexor. But oddly I didn't after the cymbalta and they are both SNRI's and you claim I don''t need the norepinephrine reuptake because it was contradicitvesince I am taking tenormin, for mild MVP w/trace regurg. and to reduce catecholomine production/surges. Anyway, to omit the Norepinephrine component, I am again looking into trying an "oldie" like daily prozac at 10mg ONLY to start OR Celexa, (even though I tried it's close relative, Lexapro that did NO good for me either), that both have a low "reported" incidence of palpaltations, insomnia, nervousness (less with the prozac) Celexa has more drowsiness 8.0 compared to none reported with Prozac? Can you advise or suggest what you might do if you were me?? I am ONLY worried about the "stimulant effect" of prozac, which I was told will go away after a while? Is this true from your experiance? And what is your take on Clexexa, Prozac "daily (NOT Prozac ER) OR just go back to cymbalta again..??? The thing is I do NOT have MAJOR DEPRESSION, it's more anxiety now but used to be panic as well, that just happen to co-exist with my Arrhythmia "unfortunately" which is like a double edged sword!

Thanks So Much
Eddie

[notahypo]

Thanks for those words of wisdom. Check out my new post it's LONG and thorough and MAYBE you and other members could give me some feedback!

Eddie

[Momto3]

My situation is not entirely the same, but has some similar components.  I don't have GERD or PD, but tend to have an anxious personality and have definitely had LOTS of ectopics.  

I had PVCs for about 25 years before they became a problem.  Even though I had many thousands everyday, there were considered benign.  I pretty much learned to live with them, and they actually felt "normal" to me.  A few years ago, I went for a routine echo to have a leaky valve checked and the doctor called to tell me I had cardiomyopathy.  Turns out I had PVC-induced CM.  I tried anti-arrythmics for several months, but eventually went for 2 ablations.  After 6-12 months, my EF normalized and I was nearly PVC-free.  I still have occasional flips and nsvt, but no longer by the minute.  My doctor has never suggested omega-3's for me, so I really can't comment.  In my case, I had PVCs regardless.  She said I would have had them no matter what I did or did not do.  

I know a few people on statins and they do not have PVCs, so that's another tough call for me...sorry.

Fortunately, PVCs are more bothersome than medically significant.  WHEW!  

As you know, different meds work differently for different patients.  That's probably part of the reason the PVCs are tough to "treat."  Are you thinking of asking the doctor to prescribe prozac for the PVCs, or more for anxiety? For me, once I adjusted to the PVCs, I preferred not to take the medication unless I had a really bad episode.  It actually took me months to adjust to life without PVCs.  Weird, huh?

[notahypo]

Fair enough. As I said I truly came to this forum to learn and share what my experiences and what I have learned from my own perspective as well as, medical professionals over the course of my 15-years of Arrhythmias/PD/GAD. I figure I could be of help to others and vice versa. My apologies to you for jumping the gun, if I did. That was NOT my intention. I would love to hear your experiences with any benign or even malignant rhythm disorders and the course of treatments, including "trial and error" therapies you may have tried yourself,when you get time. Do you have ANY information on whether Lovaza (the prescription omega'3' capsules) can aggravate PVC's specifically even though I read conflicting articles, one study saying they help with A-Fib and SCD from Sustained VT and VF but the other article written in 2005 stated that they actually may aggravate "PVC's" in general?? I can put up the links if that would be helpful to the members. I just renewed my Lovaza supplement and started taking them and could swear they increased the intensity and frequency of the Intermittent PVC's I get almost every day lately. Also, I am led to believe that the statins also may precipitate PVC's ,which I am on and have been switched a few times from Zocor to Lipitor and now back to Crestor ONLY 5mg , 10mg for the others. They also seem to definitely trigger or worsen my PVC's? I don't know if it's just a coincidence or my sensitive conduction system is being affected by these meds. I took the Lovaza, Nexium, Tenormin, .05-1mg of Klonopin as needed, depending upon my anxiety level, now that I have stopped SSRI's until I see my GP and either go back to cymbalta 20 mg or LOW dose Prozac Elixir , which my nephew Sam only 30, who is afflicted with the same problem as me,. except unlike me he doesn't get or never had PSVT (which are very rare these days) only Problematic PVC's and his NEW shrink wants to try him on very low dose Prozac initially, than switch him to the capsules when the does is or needs to be increased. I want to try the same thing, as this Doc told him that "Prozac" has the least cardiac effects, especially regarding rhythm. That's news? I figured I tried all the rest so what's ONE more try at the "best" possible cocktail, not the magic bullet mind you! That would ONLY be the 'closest" to the Magic Bullet, and even then there is NO guarantee. Momto3 if you can shed some light on your thoughts, I'd like to hear them..really!

[Momto3]

I appreciate your opinion, but still contend that the poster was not in any way being sarcastic or condescending.  I really do try and remain neutral, and only jumped in to offer some reassurance regarding your concerns.  As you said, it is a culmination of opinions and experiences that make this forum educational and informative for all of us.   Regardless of how long we have been here, or where we have learned what we know, we each have something to offer.  My apologies if you feel your contributions are/were in any way unappreciated

[notahypo]

Forgot to put that my last post was a reply to momto3.

[notahypo]

Maybe so, but I too have an excellent handle on Atrial & Ventricular Arrhythmias and being NEW here doesn't change that and my input is just as valuable! I have been seen as well as "educated" over the years about my OWN condition by many cardiologists and renowned EP doctors e.g.,  Dr. Zimmerman, Hackensack University Medical Center in NJ,  John Fischer at Montifore Hospital in NY , to name a few. I get this feeling that you Momto3 have a tendency to side with the members who have been here for "a while"! That should NOT have anything to with it or the fact you give more credence or credibility to someone who just so happens to supposedly be a nurse and has been the forum a long time. That's in a sense saying that the rest of us, are NOT beneficial to the forum. Well, FYI it may be a NEWCOMER that helps others cope or enlighten them on other therapies or cocktails, they may not yet have tried OR known about. For that, I believe it takes cumulative posts and experiences form ALL members, not just a few "senior" posters that you happen to favor.  Yes, maybe I jumped the gun and maybe slightly misinterpreted what RN Rita was saying. Nonetheless, I am entitled to MY opinion. I hope you can appreciate WHY I got slightly offended..

[Momto3]

I really believe you misinterpreted RNRita's post.  She is a frequent contributor to this forum and has an excellent handle on PVCs.  She is not trying to be sarcastic, just joining in to let you know that there are various medications and combos for patients who are dealing with anxiety, depression and/or ectopics.  I'm not sure why you feel the way you do??  

[notahypo]

Do I see you attempting to be sarcastic with me Rita? Whoever you are?? That's fine there's always a wise *** everywhere you go these days! I appologize if I am wrong but I sense a "know it all" attitude from you yet you can't cure yourself and seem to  have no faith in what anyone else says in this forum. Your last thread that lends itself to an sarcasim technically towards my nepwhew and I , in this forum, was uncalled for. With all due respect you may be an RN or the modertator, who knows, that doesn't make you GOD because you worked in a cardiac unit! There are doctors that can't put a handle this whole arrhthmia thing and don't "totally" understand "exactly" WHY WHERE and WHEN about this growing problem! So come off your high horse and realize an RN doesn't KNOW it ALL and is far from a doctor,especially an EP doctor. I thought this forum allowed ALL members to "free speech" without having to meet your expectations, as far as content and expressing our OWN views AND "KNOWLEDGE" too. The bottom line is you should use tact when you respond to those of us that endure the same thing, as do you! Don't try to be  little us because you think you been there and done that.. And although I appreciated your Suggestions/Feedback  initially and kinda "thought" you were out to "maybe" enlighten others , I don't appeciate the tone and the essence of your LAST reply and I  don't really care WHO you are! IF you are here to reply to members who are well educated about their OWN problem/symptoms and treatment approach in a condesending manner you should be removed as the moderator!
NotaHypo
Eddie S

[RNRita]

Hmmm  I've had these for 31 years and still don't know the difference between some of the sensations these things give me.  Here comes the tired old story.  I worked on a critical care cardiac unit for a year.  I used to hook myself up to the portable monitors and go through my job.  I would hear, "Hey, Rita, you're in v-tach again."  Sure enough, I would go to the monitor and see it.  The funny part was, that didn't feel as horrible as some bouts of plain bigeminy.  Then I get other weird symptoms and swear my heart is doing something awful.  I'll feel my pulse and it is steady....although thready at times.  I never like that one.

As for meds, I am sure that the atenelol and Xanax is the right combo for me.  It doesn't stop the PVCs but the atenelol helps my fast heart rate and that is more comfortable.

As for GERD and PVCs I have recently started Prilosec to help with the pain of the GERD.  It is working so far....we'll see.
Good luck in your search for the perfect drug to help stop your PVCs.  I still don't believe one exists, JMHO!

[notahypo]

We both are bearing the same cross Sam but the only difference is your 30 and I'm 52 now! If I were you I would see our cardiologist's EP doctor on Staff there now.. You are NOT obligated to do an ablation or even an EP study, as I told you over and over. Don't forget Nephew..When I first got my bout of PSVT and then the PVC's started, I was 38 years old. There has been some innovations with RF Ablation in those 15 years, Sam and there are even some alternatives to RF ablation, Cyro ablation, and I just saw on a Major news network them demonstrating a magnetic Catheter ablation tip, that is guided up an Artery to the heart NOT using Fluoroscopy / X-Rays, so the radiation is eliminated and because the guidance of the catheters is more "precise" and accurately threaded up,  there is a reduced risk of perforation of an artery. So, maybe we should just say the heck with it and both do it?? Do a search on "new magnetic RF ablation procedure" see if you can get more information and find out where they are doing it..and if it is FDA approved. What to you have to lose! Hey I am going to bed Sam, too tired and down after the funeral we went to, tonight. Talk to you tomorrow! Oh, and try asking RN Rita (the Moderator?) and dolfnlver about your concerns to, they seem to know quite a bit, too ... maybe more than your Uncle.

Uncle Eddie
NotaHypo

[notahypo]

I totally agree with you,  that while you are in remission why would you want to open Pandora's box! At the same time we still have to face reality Rita, in that , just maybe the "right combination" of anti-anxiety meds and a BB, might HELP reduce the episodes that often return with a vengeance. The ONLY reason I even opt for another medication,  in addition, to the Tenormin I am on for many years, is "HOPE". I know BB's and anti-anxiety Meds are NOT a cure-all but they do help "me" and the many people I know afflicted with the same issues/symtoms, cope. Of course, the trade-off  is feeling lousy, short term memory loss/foggy brain, cold hands/feet and "insomnia"! to name a few. of the nasty the side-effects.. I look at it like this, for "me" it's better than being on nothing, especially the Tenormin because without a doubt it controls the SVT portion of my arrrhythmia(s), very well. I get a break-through episode maybe twice or only once a year, as far as the SVT goes. I do get an occassional episode of IST or Sinus Tachycardia when my very low dose of Tenormin wears off or I forget to take it, which I truly believe when combined with the fact my cortisol/catecholomine levels are at their highest (upon awakening), and my next dose of Tenormin is due, from what I understand, can actually precipitate/aggravate a conduction disorder. Oddly enough, I am going to see my cardiologist tomorrow and request once again, (JUST IN CASE) he throw a holter monitor on me. Since the last 4-days in a row,  I have been getting PVC runs right after eating and laying down, as well as,  accompanying heartburn and GERD. This comes and goes with me and we've been down that whole road (me and my docs) about the esophogas being so close to the heart and possible vagal nerve involvement of both the cardio and gastrointestinal systems. I just want to be sure that these PVC's too, that I am specifically getting after eating are the same garden variety he already has seen over the "14 long years" are the same as ones he has ready observed and still benign. That's all. As far as, going back to try ONE more SSRI/SNRI , it may be Prozac or back to cymbalta at low doses so that the effect on norepinephrine doesn't kick in. I will let you know what the see, if anything, on the 24 hr. holter when I get the results.. I'm sure it won't just be esophogeal spasms and definately some runs of PVC's, will show up, I know the difference between the two, after all these years.

Eddie
NotaHypo

[Sicoli4]

you are a "HYPO"... only joking!! i feel your pain, uncle. i only wish there was a magical pill and it would all go away, but i now face the reality that i need meds that work for me and accept the PVC's. those are the 2 hardest things!! i have been having a horrible month with the PVC's and panic attacks. hopefully my DR visit this week will get me back on the right track.. good luck uncle! if you need support, just call!

ss

[RNRita]

I didn't do well on Lexapro nor Celexa.  In fact, I didn't do well on ANY!  I now don't bother.  One day I might try Cymbalta. I actually have samples here, but don't want to try a medication while my PVCs are in remission!  I, like you, have months of peace, but they always come back.  One of the reasons I became a nurse was to learn more about everything because I certainly wasn't being helped by the MDs.  So now I know......too much, and too little.  Enough to know how dangerous things can be and not enough to cure anything.  Humph.

[notahypo]

Thanks Rita,

I appreciate your feedback and advice and although I am NO doctor I have learned a great deal about my OWN condition and how certain meds affect"me". I know a certain meds' side effects may be different from one person to the next. I totally agree. But I still think we as patients with a little knowledge we picked up after dealing with these issues for so long, do have a good idea on what works for us and what doesn't. Only we as the patient and individuals can tell. I can't take MAO or TCA antidepresants like pamelor or even elavil , which I heard I very good for "some people" but for others these class of drugs have diet restrictions for one and can worsen "certain" arrhthmias like MOST anti-Arrhythmics (proarrhythmic effect) ,which I refuse to even try, because for one, MY PVC's are benign according to my cardiologists, even after 14 years. Yes they are extremely uncomfortable and bothersome. But I do get remissions sometimes for months, then as always they come back and can last for days, weeks, or a few months. I may try going back to Cymbalta because when I tried it for  two months I had NO real cardiac effects, other tolerable ones I guess but nothing like when I took Effexor. Any SSRI /SNRI (for me) with a stimulant sort of effect even if only initially, that might go away, I stay clear from. I looked at the low dosage profile for daily prozac and it's side effects are much lower than MOST drugs in this class/family. I even saw that Celexa was very low in MANY side effects. So I am tirn between either going back to Cymbalta even though it's labled use is for Major depressive episode. Of course, it's off label use is for anxiety. So maybe that is why that seem to calm me the best at LOW dosages and NOT aggravate my rhythm problem. BUt out of curiousity what is your take on PROZAC 10 mg daily and lastly Celexa for anxiety, so I can reduce my dependence on Klonopin or Ativan, which I have to take 3x a day with NO SSRI/SNRI in the mix?? That is ALL I  am asking. Do you have any advice as an RN, with the PROZAC and Celexa. Lexapro didn't do any good for me either and I know that is a close relative of Celexa, so maybe the Celexa would be NO good despite it's LOW side effect profile,since lexapro didn'tr work?. So that would leave me with going back to low dosage Cymbalta OR TRYING Prozac, since the palpaltations incidence is just >0.1. Nervousness, Insomnia, fatigue, constipation, dizziness, and drowsiness are NOT reported with Prozac, which I also have  issues with but they are with Cymbalta and MOST other SSRI's as well.? Go figure..Thanks for your input. what would you suggest out of the 3 or last two..??

[RNRita]

HI.  It sounds to me like you are way too deep into the pharmacology of the drugs and trying to prescribe to yourself.  We are all guilty of that here, none more than me.  I am an RN and have done exactly what you're doing for years.  They tried me on a ton of SSRIs and SNRIs and I've given up.  I really don't need an anti-depressant.  I KNOW why I get depressed and medicine can't take that away.  You can take one SSRI and it can have the same chemical as another, but one gives you symptoms and one doesn't.  There is no use in checking this out.  It is through trial and error that you will find what you need.  However, one thing I will tell you that I have heard time and again....the old medication, Pamelor, is supposed to be good for people like us who are sensitive to side effects.  So is Cymbalta.  I see you tried Cymbalta and went off it, but I'm not sure why.  I hope this helps.