What Is The Cause And Treatment For Anxiety Disorder?

Posted on Wed, 18 Feb 2015

Question: I have been on Fetzima for 2 weeks, felt good, and then the tachycardia started. I started on the starter pack of 20 mg for 2 days and then went up to the 40 mg. I called my psych nurse practitioner and she said to just stop it, stay off a week, and then start fluoxetine at 10 mg. I had taken fluoxetine for years at 10 mg and stopped about 1-1/2 years ago feeling it just wasn't helping much anymore. So, since that time of stopping the fluoxetine, my primary care doctor and now this psych NP have tried me on countless medications, always just stopping them and not weaning off. I have struggled with nausea since September and off and on new drugs. Lamotrigine made the nausea really bad, then switched to Fetzima around Christmas time and it went away. Felt good until that darn tachycardia hit me. I felt good 2-3 days after stopping the Fetzima, heart racing went away immediately. However, during the middle of the week I started sweating again and the nausea was coming back. I was supposed to start the fluoxetine on Friday, but waited until Monday because I thought maybe I could go without anything. Then Monday it hit me full force. Nausea so bad, anxiety through the roof, been taking 12.5 mg of alprazolam to try to counteract that, shaking, chills, sweating. To add insult to injury, my dad ended up in the hospital and I have not been able to get there to help out with him. I do have a therapist that has wanted me to wean off the meds but my NP did not feel the need. I am going to try to go to work today but don't know how I am going to do it! Any help would be appreciated.

Answered by Dr. Dr. Chintan Solanki (39 minutes later)

Brief Answer:
Increase dose of fluoxetine and take help of psychotherapy

Detailed Answer:
Hello Madam,

Thanks for writing to us.

From your narration it seems that yo have been suffering from some type of anxiety disorder. I read your query thoroughly and understood your concern.

In any anxiety disorder fluoxetine is going to help. In your case it was useful before but not later on. However 10 mg dose is not at all sufficient to treat problem.At least 20 mg and if needed 40 mg dose can be used for such problem.Just discuss with your psychiatrist/NP about that and increase the dose.You have tolerated it well for many years,so as per guidelines it should be restarted and optimum dose should be given.If no improvement in 4-6 weeks, you can be shifted to some other medicine.

I agree with you that you should wean off medicines. Psychotherapy specifically CBT - Cognitive Behavior Therapy is very helpful in anxiety disorder. But CBT to be effective person should be somewhat stable. Alparazolam 12.5 mg is enough high dose to say that you have severe anxiety episodes.

In my opinion, you should be stable with fluoxetine gradually with simultaneous going on CBT or other psychotherapy. After significant and satisfactory improvement you can taper off medicine under doctor's guidance and applying behavior therapy aspect in practical life.Psychotherapy can cure your problem while medicines are just controlling them likely.

Hope your dad will recover soon.

Hope my answer will be helpful to you. I will be happy to help further.

regards,
Dr.Chintan Soalnki.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Chintan Solanki (25 hours later)

Thank you, Dr. Solanki. I felt better yesterday, but am having to take that alprazolam every 8-12 hours. My big question was, do you think I am having withdrawal from the Fetzima? It hasn't gotten really good reviews. This morning I woke up at 2:30 a.m. anxious, sweaty, took another 12.5 mg and tried to sleep. I am still very anxious this morning with the nausea. I did visit my dad last night and felt good, no problems. I am just so sick of this!!!

Thank you, XXXX

Answered by Dr. Dr. Chintan Solanki (1 hour later)

Brief Answer:
Not likely withdrawal of fetzima

Detailed Answer:
Hello XXXXXXX

Thanks for writing back.

I can understand your situation of anxiety.

You are right that fetzima is not so good drug and it can cause withdrawal symptoms after stopping suddenly.

Normally withdrawal symptoms of fetzima or other antidepressant drug (also called antidepressant discontinuation syndrome) occur after use of 8 to 10 weeks of use in most of the cases.As well as it starts within a day or two of stopping a medicine.

In your case, fetzima has been taken for 2 weeks and you had not any problem after 2-3 days of stopping fetzima. They started later on.

In my opinion these are the symptoms of your anxiety disorder itself and they reappear due to controlling effect of fetzima lost. Alprazolam is controlling your symptoms also suggest that it is likely anxiety disorder symptoms.

With above consideration it is not likely withdrawal of fetzima.

If by chance it is withdrawal, symptoms decrease gradually as days progress on its own without any medicines as you had taken for 2 weeks only.But this is not the case at present.

Hope this answers your query, I will be glad to answer more queries.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj