Considering SSRIs

[StateOfRegret]

Hi all, hope you are doing well.

I have been suffering much worsened anxiety lately, to the point that I have daily (relatively mild) panic attacks and feel anxious constantly. It has affected my sleep as well - something that never used to be a problem.

Long story short: I'm considering taking an SSRI, probably escitalopram (Lexapro) or citalopram (cipramil and others).

I'm interested in your thoughts regarding SSRIs in combination with HPPD. I'm not looking for a cure for HPPD, just for the anxiety, but needless to say I am worried about exacerbating my HPPD.

Any thoughts and (especially) personal experiences are much appreciated.

[hppd33]

I took it for 7 years, it did help me a little with my Agoraphobia along with benzo's. I quit with it because it didnt work since i got hppd, a TCA would work better my new pdoc told me.

Everyone is different, you might get some relief. You probably notice some effect in 4-6 weeks, hppd till the time it will work is going to increase..

[StateOfRegret]

What exactly did you take?

As for increasing HPPD; that's my fear. I can definitely live with temporarily worsened vision, but the uncertainty about whether the worsening is permanent would be the real problem.

The visual component of my HPPD has generally been "slowly developing", meaning that it developed over the course of many trips. No one drug experience has made it dramatically worse, it just happened little by little.

Thinking about this makes me a little less worried about trying a new course of anxiety treatment.

[Syntheso]

Personally I wouldn't use SSRI's for anxiety. Whilst I know they have efficacy treating it, I would only use them as an antidepressant. I just don't really understand how making more serotonin available would help anxiety, but maybe I need to read more   (edit; well I can in the sense that if it made you 'feel better' it might help escape introverted, anxious thought processes)

As anxiety is categorised by a high arousal state I would personally look for things to calm the NS down. Have you tried these suggestions; http://www.longecity.org/forum/topic/54028-treating-anxiety-safely-effectively/ ?

Did Etizolam not help you in this regard, I would have thought so? I know you had good results with it. I have found it immensely helpful for anxiolysis, as and when I need. I can understand why you would want to move to something else though, for the reasons mentioned in the link above. Have you stopped Etizolam ? Maybe the anxiety has become bad from GABA downregulation?



 

[StateOfRegret]

Thanks for your reply, Syntheso :-)

Yes, Etizolam helps tremendously! But I have never used it daily, I use it once in a while because of the addiction potential(*).

I'm looking for more of a long term solution here, as I've come to realize that I've always suffered from anxiety to some degree. It's something that runs in the family, as well.

Before my HPPD got worse, I was always able to "power through it", but since I began having frequent panic attacks, my ability to ignore the anxiety has almost vanished.

It has come to the point where I need some sort of relief to be able to continue doing what I like. During the last few months I've been teaching mechanics at uni (physics), but with my recent anxiety surge I'm seriously doubting whether I can continue doing that. Luckily I don't have any teaching responsibilities the next couple of months, but even studying has gotten hard.

As for serotonin helping anxiety: Even though the mechanism eludes me, it's pretty clear that it works for a fair number of people (my own brother included).

http://www.drugs.com/comments/escitalopram/lexapro-for-generalized-anxiety-disorder.html

(*) Even though etizolam seems to have a lower potential for causing withdrawals etc, there are quite a few reports of unpleasant etizolam WDs online, as you're probably aware :-)

[Syntheso]

No problem   

I am sure SSRI's do help people with anxiety by some mechanism, although, I am quite persuaded by the argument Irving Kirsch makes in The Emperor's New Drugs, that mostly, in non-severe cases of depression/anxiety, the effects are felt through placebo. I've got a thing about SSRI's.. I'm not really sure why, hah. Probably because it irritates me how GP's hand them out like hot cakes. Though, to contradict myself, now my HPPD has calmed down, I have been considering SSRI's as a way of helping me out of what I now feel is a depression. 

If you think it's worth the shot - go for it. It's good for people to try meds and report back. I would personally try other things (for anxiety) before SSRI's though; did you check out the link I wrote in the last post?

One thing I think is really important whatever you decide to do, especially if you have had anxiety in the family (i.e independent of HPPD), is to do some CBT alongside what med you go for. This is something I am realising now as my HPPD is far less aggravated; that I am vastly better, but don't get up and do as much as I could because I still feel like the sufferer as long as the visuals are there. I realise that, except for the visuals, if I changed my thought processes, I would essentially feel and function normally. I have to rehabilitate my mind so that I can do way more than I am actually doing. It is no longer painful to be awake ! A slight tangent. CBT is good for anxiety though.

[Guest]

I have tried these SSRIs: Tolvon and Remeron. Because I was so fucked up, I did´nt notice much difference. I believe I did´nt have depression or anxiety, but it did nothing for my paranoia. But it may work for you.

[StateOfRegret]

Thanks for sharing, odysseus.

Syntheso: As for the longecity thread; yes, I've read that one before with interest. Actually, Lexapro is on his "approved" list ;-) I've even tried a few; niacinamide (now apparently considered neurotoxic), bacopa, magnesium etc.

The reason I'm considering SSRIs is that my particular brand of anxiety is marked by strong dizziness (sometimes vertigo as well), and it seems that CSD (Chronic Subjective Dizziness) responds well to SSRIs according to this study and others.

The anxiety and dizziness are by far my worst symptoms - much more disturbing than the visual ones (palinopsia, patterning, visual snow etc), so I'm willing to try almost anything as long as it doesn't permanently exacerbate any of my symptoms.

[StateOfRegret]

I thought I should keep you updated.

I have taken citalopram (generic) for two days, now. The first day, I started out with a low dose of 5mg to "test the waters". My experience the first day was as follows:

• Setting: Alone in my apartment on a weekday.
• I noticed a distinct "serotonergic" feeling, much like I've experienced on low doses of serotonergic drugs before (low dose MDMA or psilocybin); yawning but stimulated and a faint buzzing sensation in body and head.
• Somewhat heightened anxiety (this could be a consequence of my general 'medication phobia' which I've developed post-HPPD)
• My dizziness seemed less severe than usual - a big plus for me.
• Generally high spirits when the anxiety was not too overpowering, however my mood is usually good so this is not all that uncommon.
• Visuals worsened, ability to focus my eyes seemed worse than usual (this is a problem I have)
• I took 0.6mg alprazolam for sleep (due to the worsened anxiety)

On the second day, I took 10mg divided into two doses of 5mg each, dosed 7 hours apart. My experience was as follows:

• Setting: With family on a saturday.
• The same "serotonergic" feeling was noted, somewhat stronger following the second dose.
• Following my first dose, my dizziness seemed less severe once again. However, it came back later in the day, and a second dose didn't alleviate it, so there may be no correlation.
• Anxiety wasn't as bad this time around. May be due to multiple factors; I wasn't as scared of the medication the second time taking it, and I was with family this time rather than alone in my apartment.
• Visuals definitely worsened once again
• Yawning quite a lot, feeling somewhat tired.
• Trouble falling asleep in spite of feeling tired. When lying down with eyes closed I had a sensation of rotary motion. My body seemed to be spinning endlessly. I felt generally restless, tossing and turning (I do not usually do this).
• The worst part; I awoke a 5am (having fallen asleep around 2:30 (estimate) after going to bed at 1am) feeling utterly out of it. I was disoriented, visuals were going crazy and I was on the verge of panic. I've never awoken straight into an anxiety attack like that before. I had to take a benzo (alprazolam again) to calm down, which allowed me to sleep after an hour or so.

Today; I have not taken any citalopram today, debating whether I wish to continue doing so. I feel better in most ways today, being closer to sobriety (citalopram has a long half life). The visuals still seem worsened, but not as bad as when the citalopram was in full force, so I'm hoping that the worsening is temporary.

[hppd33]

I thought I should keep you updated.

I have taken citalopram (generic) for two days, now. The first day, I started out with a low dose of 5mg to "test the waters". My experience the first day was as follows:

• Setting: Alone in my apartment on a weekday.
• I noticed a distinct "serotonergic" feeling, much like I've experienced on low doses of serotonergic drugs before (low dose MDMA or psilocybin); yawning but stimulated and a faint buzzing sensation in body and head.
• Somewhat heightened anxiety (this could be a consequence of my general 'medication phobia' which I've developed post-HPPD)
• My dizziness seemed less severe than usual - a big plus for me.
• Generally high spirits when the anxiety was not too overpowering, however my mood is usually good so this is not all that uncommon.
• Visuals worsened, ability to focus my eyes seemed worse than usual (this is a problem I have)
• I took 0.6mg alprazolam for sleep (due to the worsened anxiety)

On the second day, I took 10mg divided into two doses of 5mg each, dosed 7 hours apart. My experience was as follows:

• Setting: With family on a saturday.
• The same "serotonergic" feeling was noted, somewhat stronger following the second dose.
• Following my first dose, my dizziness seemed less severe once again. However, it came back later in the day, and a second dose didn't alleviate it, so there may be no correlation.
• Anxiety wasn't as bad this time around. May be due to multiple factors; I wasn't as scared of the medication the second time taking it, and I was with family this time rather than alone in my apartment.
• Visuals definitely worsened once again
• Yawning quite a lot, feeling somewhat tired.
• Trouble falling asleep in spite of feeling tired. When lying down with eyes closed I had a sensation of rotary motion. My body seemed to be spinning endlessly. I felt generally restless, tossing and turning (I do not usually do this).
• The worst part; I awoke a 5am (having fallen asleep around 2:30 (estimate) after going to bed at 1am) feeling utterly out of it. I was disoriented, visuals were going crazy and I was on the verge of panic. I've never awoken straight into an anxiety attack like that before. I had to take a benzo (alprazolam again) to calm down, which allowed me to sleep after an hour or so.

Today; I have not taken any citalopram today, debating whether I wish to continue doing so. I feel better in most ways today, being closer to sobriety (citalopram has a long half life). The visuals still seem worsened, but not as bad as when the citalopram was in full force, so I'm hoping that the worsening is temporary.

SSRI´s work optimal in 4/6 weeks, you cant say after 3 days it isnt working. I used it 7 years, and stopped it 4 weeks ago, i can tell you that it worked for my `mild DP-DR` and aghoraphobia.

[StateOfRegret]

SSRI´s work optimal in 4/6 weeks, you cant say after 3 days it isnt working. I used it 7 years, and stopped it 4 weeks ago, i can tell you that it worked for my `mild DP-DR` and aghoraphobia.

I am well aware of that. But I will have to gauge if the effect they have had on my visual symptoms is permanent. If it is, there is no way I will continue taking them for months, since this could be very detrimental.

[StateOfRegret]

Well, now I've been taking escitalopram (generic Lexapro) at 5mg/day for 4 days. Definite reduction in anxiety already, but my visuals seem markedly worse. I hope that is temporary :-S !

[LaizzesFaire]

Well, now I've been taking escitalopram (generic Lexapro) at 5mg/day for 4 days. Definite reduction in anxiety already, but my visuals seem markedly worse. I hope that is temporary :-S !

I´ve been taking Sertraline (Zoloft 50mg/day) for about a month and a half now. Anxiety, depression, DP/Dr, OCD tendencies significantly reduced. Had an increase in visuals (mainly afterimages, ghosting and movement of objects/text) for the first 4-5 days but after that it stabilized at this "new level". For me the tradeoff has been worth it because its easier to ignore when anxiety is low. Don´t really want to increase the dose tho. Good luck

[Syntheso]

Interesting! See this.

 

This concurs with your experience LaizzesFaire;

Young, C. R. (1997). Sertraline treatment of hallucinogen persisting perception disorder. Journal of Clinical Psychiatry, 58(2), 85-85. 
 

Reports the case of a 22-yr-old man who presented with hallucinogen persisting perception disorder and symptoms of mild depression 6 mo after discontinuing the use of LSD. Antidepressant treatment was begun with sertraline, until a target dose of 100 mg was reached. Mild exacerbations of the LSD-like phenomena were noted for 2-4 days after each dosage increase. Within 1 mo of reaching the target dose the perceptual disturbances decreased until they had almost completely remitted, and the depressive symptoms also improved. It is hypothesized that hallucinogen persisting perception disorder is serotonergically mediated, and that sertraline initially exacerbates the perceptual disturbances, but attenuates them after chronic administration. 

 

[Ghormeh Sabzi]

Look into bupropion.

[LaizzesFaire]

Interesting! See this.

 

This concurs with your experience LaizzesFaire;

Young, C. R. (1997). Sertraline treatment of hallucinogen persisting perception disorder. Journal of Clinical Psychiatry, 58(2), 85-85. 

 

 

Yes, it was after stumbling upon that study I decided to give it a go. No remission at this point unfortunately. Perhaps I should try an increased dosage after all, just to see if something happens.

[StateOfRegret]

Thanks for sharing, guys - especially you, LaizzesFaire!

What dose are you on?

I'm only on 5mg of S-citalopram, which isn't even usually considered a therapeutic dose (more of an "introductory" dosage level). I'm considering increasing it to 10mg. It's already helping my anxiety significantly at 5mg, though.

 

Syntheso: I remember reading that account a long time ago. I have found the visuals to be continually worsening (7 days in), but I'm hoping it'll at least "level out" soon. I guess this goes to show that visual symptoms and anxiety levels do not always go hand in hand.

[LaizzesFaire]

No problem! I´m currently taking 50 mg/day, started off at 25 mg for about 5-6 days then increased the dose. The exacerbation of visual symptoms happened during these first days, but there wasn´t really any difference when going up to 50 mg. I do feel very weird whenever I forget to take the medication (dizziness, buzzing sensation) and have a harder time falling asleep in general. But again, as long as the visuals doesn´t drastically flare up Im sticking with this for now, until I can get a Keppra trial.

[StateOfRegret]

Time to report back!

I took escitalopram at a fairly low dose (5mg/day) for 2 weeks to the day before giving it up (not necessarily for good).

The good:

• Definite anxiolysis for the first week. 
• Lessening (near obliteration) of "unhelpful thoughts", specifically rumination about the effects that various fairly innocuous substances could have on me (caffeinated drinks, NSAID painkillers etc)

The bad:

• Feeling "spaced out" the entire time
• Worsening of visual symptoms (subsided after discontinuation!)
• My memory seemed shot, I would forget where I'd been/what I'd done.
• Excessive sweating and feeling hot.
• Awakening every night almost exactly 130 minutes after falling asleep feeling physically very strange and spaced out, with strong visual distortions.
• Feeling somewhat emotionally "flat", unmotivated. I'm usually very "enthusiastic" about lots of things. 

I awoke one night feeling extremely physically tense. It took me a few minutes to identify this as a panic attack of sorts, since no intense feeling of dread or racing thoughts accompanied the physical sensations. I was able to simply get out of bed, awake my mother (I was visiting the family) and say "I feel strange, I'd like to talk for a minute, but I don't think anything's seriously wrong". Normally, I'd have been almost unable to speak during a panic attack.

 

The reason I quit was because all the unpleasant side effects were only increasing in strength after a week, while the anxiolysis seemed to be waning.

 

I've been off it for exactly a week now. The last week has been better in some respects, worse in others. I've been sleeping much better, feeling generally happier than when I was on the drug (the emotional flattening subsided, I can feel joy/enthusiasm to a greater extent now), but the "unhelpful/irrational" thoughts are back, and so is the anxiety. Getting rid of the "spaced out" feeling was such a relief, though! 

 

Curiously, escitalopram did nothing good for the dizziness/vertigo that I struggle with. In fact, it somewhat worsened it. This is interesting, since I've been led to believe that the dizziness is a product of my anxiety.

[BigPapaChakra]

Look into the OCT2 protocol I posted about. Outside of Theta-Alpha-Gamma Synchrony neurofeedback, that's what I'm really looking into as of now. I believe it has tremendous potential to help us HPPDer's, along with anyone suffering from PTSD, major depression, etc.

 

Thanks for the update, though! I believe our experiences are much needed to help each other.

 

If you don't mind me asking, what are your plans now?

[StateOfRegret]

[...]

If you don't mind me asking, what are your plans now?

None, really (except for Keppra, of course, but we're talking anxiolytics/anti-depressants here).

I've no reason to think that other SSRIs will have fewer unpleasant effects. I often see tri/tetracyclic anti-depressants and bupropion mentioned somewhat favorably on these boards. As for tri/tetracyclics, most of them are SRIs as well, only with more of a scattergun pharmacological profile. Bupropion usually isn't useful for anxiety - more-so for depression, which I don't have. Buspirone is another option, but it seems pretty ineffective for the majority.

[BigPapaChakra]

The buspirone+melatonin study showed some beneficial results, as I'm sure you're aware of. I've been thinking of trialing that myself for 6 or so weeks. I've come across an extensive list of reliable online pharmacies though have yet to use any of them. 

 

Definitely look into the OCT2 protocol, though. There is a list of practitioners trained in the protocol, too. I recently contacted one, but currently need the funds for other testing. I also called the man who is continuing the research on OCT2 and told him about HPPD and the co-morbid disorders. Hopefully he gets back to me. Oh, and as I was typing this I literally just remembered Dr. Fuad Lechin and his seemingly efficacious neuropharmacological treatments for even non-neuro-psychiatric disorders.

[dreamboatqueen]

Hey, I too was really paranoid about exacerbating my HPPD symptoms. Before HPPD i already had chronic depression, so its pretty important that I take an anti-depressant. I went onto Lexapro as i developed anxiety, only the smallest dose, 5mg, which has helped alot! Symptoms have sort of remained the same, not really sure if they've increased but it diminished my anxiety and lifted my mood a little.