Common sequela: anxiety and OSA

ZZZzzz · Post by **ZZZzzz** » Sun Jun 03, 2007 10:14 pm

Sammy -

I split a Lexapro tablet in half and I was on 5 mg a day.

I did the same with Ambien and took 2 and a half mg at night.
I think Ambien works awesome and NO hangover drowsiness.
Who can afford to be drowsy?

I thought I would have a hard time giving up Ambien but I don't use it that often any more. I think I forgot to take it one night and realized I slept very well!

-Bev

Sammy_J · Post by **Sammy_J** » Mon Jun 04, 2007 12:13 am

Thanks ZZZzzz. So you had no problems with the Lexapro?

BTW, has anyone tried CBT (Cognitive Behavior Therapy)? The one time visit to a psychiatrist wrote in his report that I should try this as it may be just as helpful as meds themselves.

lawdognellie · Post by **lawdognellie** » Mon Jun 04, 2007 1:07 am

CBT can be very helpful, but it depends on your psychiatric condition. It's always good to be able to see how your own thought process may be sabotaging getting better from depression. I did it for a while and it helped me to learn better ways to deal with one of my downward spirals of depression. It also helped me learn to differentiate between when I'm thinking negatively and when the situation really is negative.

BTW, someone posted earlier that they were "addicted" to lexapro and couldn't come off it until they switched. First, one isn't actually addicted to anti-depressants, they are physically dependent. There is a major difference. When one is addicted they will continue the drug/behavior/etc. at the expense of their welfare and well being. For example, a drug addict will not pay rent to feed their habit, even when the habit makes them non-function. Being physically dependent means your body has gotten used to it being in the system and will suffer from withdrawal if you quit cold-turkey (but you won't be jonesing for lexapro in a year). Anytime you come off an anti-depressant it is extremely unsafe to quit cold turkey. Depending on the anti-depressant, it can cause things like heart attacks. One must always wean off the drug slowly. This gives the body the ability to adjust without causing withdrawal symptoms. For instance if one is taking 10 mg of lexapro, take 5 mg for a couple of weeks then quit.

Sarah

socknitster · Post by **socknitster** » Mon Jun 04, 2007 12:46 pm

BTW, someone posted earlier that they were "addicted" to lexapro and couldn't come off it until they switched. First, one isn't actually addicted to anti-depressants, they are physically dependent. There is a major difference. When one is addicted they will continue the drug/behavior/etc. at the expense of their welfare and well being. For example, a drug addict will not pay rent to feed their habit, even when the habit makes them non-function. Being physically dependent means your body has gotten used to it being in the system and will suffer from withdrawal if you quit cold-turkey (but you won't be jonesing for lexapro in a year). Anytime you come off an anti-depressant it is extremely unsafe to quit cold turkey. Depending on the anti-depressant, it can cause things like heart attacks. One must always wean off the drug slowly. This gives the body the ability to adjust without causing withdrawal symptoms. For instance if one is taking 10 mg of lexapro, take 5 mg for a couple of weeks then quit.

Sarah

Sarah, that was me and you are right, there is a difference. It doesn't feel like it though when you are weaning off the drug and having terrible symptoms--I kept thinking I would do anything to make the discontinuation symptoms stop including go back to taking the lexapro again. Which I actually did a few times!

And weaniing off slowly is no guarantee you won't experience the symptoms. My doctor weaned me over months, very, very slowly, from 20 to 10 to 5 to 2.5 mg. Once I got past the threshhold of 5 mg my body freaked out. Can you imagine caring for a boisterous 3-year-old when having dizzy spells, headaches, brain zaps and extreme irritibiity! Awful.

So, I'm sorry if I was less than perfectly accurate, it is an emotional sorespot for me! I hope when I wean off the prozac it will go easier. We chose this one because it is easier to wean from and considered safer for pregnancy--I didn't want to get pregnant on lexapro and we are ready to expand our family. That will have to wait until I'm breathing all night while sleeping. I don't advise being pregant with undiagnosed apnea. Not a pleasant experience! Jen

Sammy_J · Post by **Sammy_J** » Mon Jun 04, 2007 3:25 pm

lawdognellie wrote:One must always wean off the drug slowly. This gives the body the ability to adjust without causing withdrawal symptoms. For instance if one is taking 10 mg of lexapro, take 5 mg for a couple of weeks then quit.

socknitster wrote:And weaniing off slowly is no guarantee you won't experience the symptoms. My doctor weaned me over months, very, very slowly, from 20 to 10 to 5 to 2.5 mg. Once I got past the threshhold of 5 mg my body freaked out. Can you imagine caring for a boisterous 3-year-old when having dizzy spells, headaches, brain zaps and extreme irritibiity! Awful.

I have been reading up a lot on Lexapro and Jen's experience is very typical. You just can't wean yourself off the drug like that, it can take YEARS! and during that time you will want to go back and most people do and then suffer the consequences. That's why many say that if they knew now what they knew then, they will not go on SSRI's, SNRI's, tricyclics, or Benzos.

socknitster · Post by **socknitster** » Mon Jun 04, 2007 8:02 pm

That's why many say that if they knew now what they knew then, they will not go on SSRI's, SNRI's, tricyclics, or Benzos.

I am sure that is true, but I also can't dispute the fact that in the face of undiagnosed apnea, lexapro made daily life more possible. It helped me get through some really rough times.

I don't think ssri's are the devil, I just think they aren't well understood yet. Brain chemistry is in its infancy. They really don't know HOW these chemicals work, only that they DO work.

In my case the answer was switching to a different ssri that is easier to wean from because it has a much longer half-life. (Lexapro has a very short half-life which is one of the reasons it wreaks such havoc upon discontinuation.) So, now I'm on prozac which I have successfully weaned from without side effects before.

In fact, to be honest I have been on and off various antidepressants over the last 10 years and never had cessation symptoms like that before. In my 20's I would just decide, "oh, that is it, I don't need this anymore," and wouldn't have any noticeable issues. This last time, I presume it was the fact that my body was under so much stress from undiagnosed apnea that probably led to harsher discontinuation symptoms.

I was so depressed/tired/stressed out that I would have thoughts like, "I could drive off this bridge and end this right now." Ummm. I'm glad to be still alive! Thank you lexapro!

Sure, in a perfect world my severe osa would have been diagnosed and MAYBE I would never have needed that stuff (maybe I would--who knows!), but that isn't the way life is. While it is interesting to look back and say, "aha, that was probably apnea even then," it doesn't do me any good now to get more than a little irritated that it was missed. My life is good now. I have a great kid, happy family life, lots of hobbies and friends. If I had driven off that bridge I wouldn't have any of that or the satisfaction of finally having the correct diagnosis. So, thank you lexapro for making that possible.

Information is the key--if I had to take it again, I would but I would have a strategy for getting off (luckily I had a psych who let me put in the hours of research and try different techniques that he would never have thought of on his own!)

So, now I'm rambling, sorry! Jen

wog · Post by **wog** » Mon Jun 04, 2007 8:30 pm

This is a fascinating thread. I suffer from a pretty severe case of GAD. Been there done that on all the SSRI's, SNRI's, SSNRI's, Anxiolytics etc. OSA as a contributing aggravator to anxiety makes much sense. Now that I look back, it appears that my increase in anxiety coincides with my deterioration of sleep quality. Which also coincides with some weight gain... And boom, I'm in a vicious cycle.

I've been back on CPAP for just about 8 weeks now. I have been 100% complaint since day one. Unfortunately, I am not yet enjoying much relief from my symptoms of anxiety. Nor, I am feeling perky enough to work on the weight. But I've decided to focus on improving the quality of my sleep... And soon, I hope, I will start feeling some relief. I'm really thinking there's something to all of this. Well, hoping anyway.

Jere · Post by **Jere** » Mon Jun 04, 2007 8:36 pm

Yikes! This thread reminds me of the years of being on Zoloft then Serzon and then back to Zoloft, suffering from the side-effects (the ones the doctor never tells you about). The meds were supposed to relieve my anxiety and depression (not to mention chronic insomnia). Every time I tried to get off any of them, I would get the 'zaps' (my GP had no answer to that) and getting off Serzon brought me as close to suicide as I ever want to be. Yuch.

I complained and complained that none of these medicines were helping. Finally, my psych referred me to a psychopharmacologist. After maybe two visits, and a long discussion about the psychotic behavior running through my mother's family (probably bi-polar), he put me on a low dose of lithium. I was skeptical at first (I have never been manic), but the stuff has been a great help. Anxiety is manageable and depression is almost gone. Insomnia is under control and I am off Ambien altogether. Add CPAP to the equation, and I have been sleeping at night and staying awake during the day. I don't ask for much, but being able to sleep at night and to remain awake during the day - well, it's priceless.

Doctors can be very quick to put people on antidepressants. They might work for some people, but they did not work for me (actually made things worse).

For me there is no noticeable link between OSA and anxiety. My anxiety is inherited and the OSA a coincidence.

_________________

As for weaning off antidepressants, here is what works for me. First, every step/reduction takes two weeks. First, I cut 1/4 off my dose, then another 1/4, then another 1/4 (leaving me with a 1/4). I would then cut that 1/4 in half and finally - 8 weeks later - stop altogether. Still got minor zaps and some mood instability for a few weeks. The key is to GO SLOW. Never, ever go cold turkey.

jskinner · Post by **jskinner** » Mon Jun 04, 2007 8:39 pm

socknitster wrote:dizzy spells, headaches, brain zaps and extreme irritibiity! Awful.

Oh man that brings back terrible memories. I sometimes wonder how I made it though the withdrawal ten years ago.

socknitster wrote: They really don't know HOW these chemicals work, only that they DO work.

Tell that to the families of people who's loved ones have killed them selves when doing though withdrawal. Fact is they don't always work, sometimes they make things worse. SSRI's have had more adverse drug reaction reports than any drug in history! The FDA is now re-investigating the pre clinical data and there has been growing evidence that you are in fact more likely to kill yourself if you take and SSRI than if you don't. The current FDA probe has been largely due to the work of David Healy in response to his recent book called 'Let them eat Prozac'

http://www.healyprozac.com/

I think antidepressants should be a last resort. CBT and therapy should be the first. SSRIs are given out like candy these days. Its shameful. I've had friends prescribed SSRIs because they have had a breakup, a family member die, etc. These are normal life events and if one is struggling with them then they need support and counciling not drugs.

I think/hope SSRIs will one day be looked at other psychiatric drugs of the past ( cocaine, lsd, etc)

Of course all of this is just my opinion. Maybe others will have different ones.

Justin_Case · Post by **Justin_Case** » Mon Jun 04, 2007 10:59 pm

Jere wrote: Anxiety is manageable and depression is almost gone. Insomnia is under control and I am off Ambien altogether.

Doctors can be very quick to put people on antidepressants. They might work for some people, but they did not work for me (actually made things worse).

But, you're already dependent on a drug (lithium). So, there is no difference except in semantics. You're a victim already. The lithium you are taking is harming you, whether you accept it or not.

roster · Post by **roster** » Tue Jun 05, 2007 5:30 am

jskinner wrote:..................

.............

I think antidepressants should be a last resort. CBT and therapy should be the first. ..................

I agree with your post, but would add that maybe the Berlin questionnaire (and appropriate follow up) should come before CBT and talk therapy.

socknitster · Post by **socknitster** » Tue Jun 05, 2007 7:10 am

The word victim is a little strong here, don't you think? Aren't we all just trying to do the best we can? In this day and age medical care is just so complex, we HAVE to be our own health advocate. Gone are the days where you just trust the doctor knows more about it than you do, like my grandfather did. Now when you get a diagnosis you have to become educated on every facet, every possibility, to manage your own care. I can't tell you how many hours I have spent researching health topics to try to brainstorm with my docs about what is wrong with me.

I don't regret taking antidepressants because for me, in the face of undiagnosed apnea, it was the only way I survived! Since there is no way I could know that when I am unconcious I am not breathing, it is kind of hard to give that as a symptom to your doc!

If Jere needs to be on lithium to stay sane, then more power to him or her. Would you rather Jere be dead? It is easy to say that Jere shouldn't be on lithium, but maybe, just maybe that is the only way he or she can stay sane right now. I would rather be medicated and FUNCTIONING than sitting in my chair all day practically comatose while my son begs for my attention and grows up without a responsive parent!

Is my true diagnosis depression, probably not! Was something missed? Definitely! But until I can get my treatment under control and start breathing when I sleep I NEED to be on something or I might as well just stay in bed all day--that is the good I would be able to do my family without prozac! It is helping me cope in the face of very, very severe apnea. I stop breathing every two freaking minutes--without prozac I am completely unstable, and practically comatose. I am soooooo glad I didn't have to suffer without it. I am not a victim, I am a survivor.

Jen

jskinner · Post by **jskinner** » Tue Jun 05, 2007 7:30 am

socknitster wrote:...

Hey Jen,

I personally didn't mean to offend you in anyway. I am sorry if I did, I appologize.

I was just giving my (very strong) opinion on the subject. I spent almost 10+ years taking different SSRIs. I just think that doctors giving out these meds should be more informed about sleep apnea and try to find the real causes of problems rather than forcing one to feel better chemically. Had my sleep apenea been found years earlier rather than being dismissed as depression I have no doubt it would be as bad as it is today.

socknitster · Post by **socknitster** » Tue Jun 05, 2007 9:02 am

I personally didn't mean to offend you in anyway. I am sorry if I did, I appologize.

Hey, no offense taken. This is a serious subject and people have strong feelings, understandably! I am a little angry too--I too have been misdiagnosed with depression for about 10 years. However, what we have to be angry about is the fact that science isn't catching up fast enough to teach doctors in med school about all the possibilities and how to check for apnea when someone comes in with symptoms of depression.

I just discovered that maybe if I had followed thru with treatment for "silent gerd" that I might not be in the boat I am today either! That one is my fault. Not liking to take meds unnecessarily, just like you, I decided that if the "silent gerd" didn't really bother me, there was no reason to treat it. After all, all that had happened was I just happened to mention to my ent that I had a feeling like a big glob of snot that won't go away in the back of my throat. A little irritating to be sure, but not life threatening, or so I thought.

Now was he supposed to take that info along with a mention of being treated for depression on my questionaire and figure out that I need to be tested for apnea? Maybe. That is a big leap, in my opinion.

Had I continued treatment with over the counter acid reducers like he mentioned I probably should, would I be dealing now with a bipap pressure of 16/12 cm H2O? Who knows. It is damn complicated, isn't it?

All I can do now is go forward and be the best advocate for myself that I can. I actually do know a few people on antidepressants. We live in a stressful world. I don't know if they should be on them or not--that is up to them to decide. What I do know is that ignoring a diagnosis, whether a good one or not, a perfect one or not, or even one that is part of a much bigger picture can lead to much worse consequences!

Apnea is so complicated and overwhelming. Hope I didn't hurt YOUR feelings with my rant last night! I'm still in the earliest stages of figuring this out and I am immersing myself in information and a little emotional!

Keep talking about it, it is the only way to figure it out.

Jen

jrgood · Post by **jrgood** » Tue Jun 05, 2007 1:15 pm

I'm in the interesting position of having just starting an antidepressant because after 12 months of unsuccessful attempts at tolerating CPAP it's my last ditch attempt to sleep soundly enough to tolerate the treatment.

I have lots of confounding factors - some that apnea probably caused or contributed to. Hypothyroidism, fibromyalgia, low cortisol, GERD.

I was misdiagnosed in the beginning as well. With depression and dysthymia. Now I'm properly diagnosed and using an antidepressant to help with my treatment. The irony!

So I agree Jen. Each person's situation is different and complex.

While I'm sure there are lots of doc's prescribing AD's at the drop of a hat, I personally have never met someone who wasn't completely conflicted and ashamed at starting an AD and only started it as the very last resort after trying everything under the sun (at great expense) first.

Jenny

Common sequela: anxiety and OSA

Lex ?