Just started anxiety medication, having severe anxiety attacks

May 16, 2013 4:03 PM

I just started taking 5mg of cipralex three days ago and am currently having the worst anxiety attack of my life. It's almost physically painful. Is this normal? I haven't felt like this since I had a seriously bad trip on mushrooms!!

Mentally I feel mostly ok, it's just like there's an alarm going off in the back of my head freaking out and I'm sweating. It's a nice day out, nothing bad happened or is happening, this is surreal. I feel slightly stoned as well and have a bit of the stupids, which isn't helping.

If it is normal, how do I deal? Bad effects are supposed to wear off after two weeks, but I don't think I can handle this for that long. Honestly, the generalized anxiety and depression were much much easier.

posted by anonymous to Health & Fitness (29 answers total)

Best answer: I've been on and off anti-depressants a few times, and I've had bad side effects (mostly sleep-related) when I've started a few. If you're having really awful side effects, I'd say call your doctor to talk about it, and seriously consider getting off the drug and trying another. When one of these drugs isn't right for you, the side effects can be like taking some bad acid or something. Don't put yourself through two weeks of this if you don't have to.
posted by Ursula Hitler at 4:09 PM on May 16, 2013 [1 favorite]

Isn't it horrible how some medications that are supposed to help you wind up almost killing you? I had this happen a few years ago with Zoloft, OMG I will never do that again. And yet I know other people who say it saved their life. Go figure.

Anyway, from what I understand it won't be a horrible two weeks, you should start feeling better within a day or two after you stop taking it. Good luck.
posted by Melismata at 4:11 PM on May 16, 2013

I had something very similar starting fluoxetine (on day 3! twinsies!) - I got very jittery and warm and felt "high" in a very unpleasant way. I did need to go lie down and take deliberate, slow breaths for a while, but I continued to take it and it never happened again. You might want to call your doctor, though my bet is that they will say something calm and reassuring. Obviously IANAD and YMMV.
posted by en forme de poire at 4:16 PM on May 16, 2013

This happens to me whenever I start an anti-depressant, or whenever my dosage is ramped up. It ought to get better soon. It definitely happens to me when I take Lexapro/Cipralex.

I'd talk to your doctor about whether or not the side effects are so bad that it's not worth waiting them out. But it's also possible that you'll do just fine after this initial crappiness.
posted by Coatlicue at 4:17 PM on May 16, 2013

Unfortunately, based on my experience with SSRI medication, it's probably normal, and will go away or lessen significantly in the next couple of days if you can hang in there.

Here's the scary thing - going off of it will likely be a replay of this same scenario.

If it helps you when you reach a comfortable baseline with the stuff, that's terrific - but going off and on can be absolutely hellish.

I am not your doctor, or any doctor - I'm just a guy who took stuff for a long time.
posted by kbanas at 4:19 PM on May 16, 2013

I had this when I started Lexapro (off it now), even with a small dosage and within the first hour of taking it. The doctor thought I was bullshitting him. I'm with you on the bad mushroom trip analogy.

It's going to sound a little silly, but what worked for me was getting out of the house and walking, keeping my body busy and my mind busy with new stimulus. The panic came and went, but got better.
posted by hanoixan at 4:22 PM on May 16, 2013

I feel slightly stoned as well and have a bit of the stupids, which isn't helping.

Seems like maybe you should talk to your doctor and see if the dosage is too high.

Or, conversely, you are a fast metabolizer and you are feeling the SSRI discontinuation syndrome every day as the drug metabolizes out of your system. Maybe a switch to something even longer lasting like fluoxetine might be in order?
posted by gjc at 4:26 PM on May 16, 2013

Thanks everyone. I think I'm going to quit taking it, I can deal with my generalized anxiety and malaise, but there's no way I can handle even just two weeks of this. The Dr said if I had any bad reactions within the first few weeks I could just quit taking it, so this isn't running against dr's orders (I'll also call tomorrow, but I don't think I'll be able to get in to see them for at least a week).

Does anyone have experience with going off an SSRI they've only been on a few days? Am I going to have to go through this again before things are back to normal?
posted by Dynex at 4:37 PM on May 16, 2013

Panic disorder is associated with long QT syndrome, and cipralex can cause the QT interval to lengthen, and is generally contraindicated for people with QT interval problems.

I think you should definitely quit taking the cipralex, and should also look into whether your anxiety might be caused by underlying long QT syndrome, because that can be pretty dangerous.
posted by jamjam at 4:59 PM on May 16, 2013

Haha, oh god, don't tell someone in the middle of a chemical anxiety attack their heart is about to explode!!
posted by Dynex at 5:06 PM on May 16, 2013 [18 favorites]

Best answer: You won't have any discontinuation side effects from only being on an SSRI for a few days. My psychiatrist says that even if I stop lexapro after one month cold turkey I won't experience any side effects. I know when I took a high dose of zoloft for a few months and decided to quit cold turkey, I felt odd for a few days but it wasn't terrible by any means.

Most if not all SSRIs cause a ramp up in anxiety for the first 1-2 weeks. I recently started lexapro, and even taking 5mg (half of the smallest prescribed dose) I seriously felt like I was coming up on acid the whole day in a very unpleasant way. When I turned out my lights, I found I was actually hallucinating a little (shape shifting and such). Thankfully it went away after a week, and I feel fine on 10mg now.

Most doctors are willing to provide at least a small benzo script (something like lorazepam) for people who are starting off on SSRIs because these symptoms of increased anxiety are so common. If your doctor is not willing to do that for you I would consider getting another one.
posted by WhitenoisE at 5:09 PM on May 16, 2013 [2 favorites]

Sorry-- I tried to soft-pedal it a bit.
posted by jamjam at 5:22 PM on May 16, 2013 [1 favorite]

Yes, I had that, and no, I will not go back. Tried all of them and frankly, not for me.

One thing you may consider is Hydroxyzine, which is an old school antihistamine that helps anxiety (not a benzo). It is very mellow and may make you a bit tired the next morning, but it WILL stop the heart palpitations and is not addictive. I don't even have to take it that often, but it's there if I need it.

In the meantime, consider benadryl at night.

Non med things include taking a B vitamin complex in the morning, limiting caffeine and sugar, exercise early in the day -- or really, any activity -- including protein in every meal, a D and magnesium at night, and some really good relaxing books, plus maybe a fan for white noise, even if it's pointed away from you.

(Have had my heart checked out thoroughly including ultrasound so YMMV)
posted by Marie Mon Dieu at 5:32 PM on May 16, 2013 [1 favorite]

An alternative to going off of the medication is to cut the pill in half. Reducing the dosage should lessen your side effects. You can also get good advice from a pharmacist. You just need to call them.
posted by kitcat at 5:38 PM on May 16, 2013

I was already cutting the pill in half, 5mg is half the smallest amount you can get.
posted by Dynex at 5:42 PM on May 16, 2013

FWIW my doctor also told me going off Klonopin was cool but I had some really adverse side effects so I would taper and/or have a friend or trusted relative nearby when doing so. Because my dad later questioned the whole thing, having had direct experience with a relative going off similar meds. Everyone responds differently so don't worry, but still let people know and keep someone nearby just in case.
posted by Marie Mon Dieu at 5:43 PM on May 16, 2013

If your doctor doesn't want to give you a benzo, consider asking if you can have a small prescription of Inderal for the duration. It's a beta-blocker that does a good job at soothing some of the physical freakout symptoms of anxiety, and especially if the panic attack isn't accompanied by actual anxious thinking, can sometimes make all the difference in the world.

(I occasionally have bad responses to my ADD meds and have anxiety besides, so I have both an ongoing prescription for Inderal and a benzo, and I take the Inderal more often and it usually works better.)
posted by Sequence at 5:45 PM on May 16, 2013

IANAD. Please call your doctor before you decide to do anything and you should ask about taking a benzo while the meds settle into your system.
posted by kinetic at 5:55 PM on May 16, 2013 [1 favorite]

omg, don't freak out about long QT syndrome, it is a total zebra here. Chemically-enhanced panic is not that abnormal when starting out on an SSRI and you should feel better soon. Call your doctor, that's what s/he's there for.
posted by en forme de poire at 6:49 PM on May 16, 2013 [3 favorites]

If you are in the US your medication should have a pharmacists number on it, if you can't reach your doctor then call that number and ask for advice.
posted by Blasdelb at 7:14 PM on May 16, 2013 [1 favorite]

Panic disorder is relatively common, an estimated 1 to 5 of every 100 people have panic disorder at some point in their lives.

Long QT syndrome is rare, estimated prevalence is 1 in 10,000 people. Also, long QT syndrome does not cause anxiety (except when people on internet forums try to diagnose you with it).

So I'm going to have to agree with en forme de poire here that we ought not be talking about zebras when hearing these particular hoofbeats.
posted by treehorn+bunny at 9:13 PM on May 16, 2013 [2 favorites]

IANAD.

Get a pill cutter. Dose up very, very, very slowly. Start with 1/8 a pill.

SSRIs often cause really bad anxiety when starting them, and sometimes when dosing up. But most people are fine if they titrate very slowly.
posted by professor plum with a rope at 1:22 AM on May 17, 2013

I have a lot of experience of taking psycho active medicines. I no longer take them. The side effects are horrible. The benefits are negligible. Read Ben Goldacres bad pharma for a detailed rigorous argument.
posted by BenPens at 3:21 AM on May 17, 2013

Best answer: Just two weeks ago I took 5mg Cipralex for 7 days, with a variety of unpleasant side-effects, but bad enough that when my wife said we were going to have to change some travel plans because of it, I realized I had to stop. I had immediate improvement the first day off it, and by the second day I was totally fine. If you do stop, I would hope your recovery is as easy as mine.

I should add that my doctor has said it may take several tries to find a med that works, so trying one at a low dose for a short period to see what happens is just part of the process.
posted by valleys at 6:25 AM on May 17, 2013 [1 favorite]

Best answer: One way to help a panic attack is to put a cold wet washcloth on your face. Cold water on the face induces the Mammalian Dive Reflex, and can stop a panic attack. No side effects. I learned this from starting Prozac and having some classic panic attacks.
posted by theora55 at 8:20 AM on May 17, 2013 [2 favorites]

Thanks everyone, I spoke with my Dr and he told me to stop taking it it, which was good because there's no way in hell I was going to continue. He wants to try some different ones, but honestly I'm done with fiddling with brain chemicals. I'm still feeling really off.

Just for the record, I don't have panic disorder and I've never had a panic attack like that for no reason. I now have great sympathy for those who do, holy crap that was awful.
posted by Dynex at 9:33 AM on May 17, 2013

Don't let a bad reaction scare you from getting the help that you thought you needed before.
posted by gjc at 1:50 PM on May 18, 2013

Long QT syndrome is rare, estimated prevalence is 1 in 10,000 people. Also, long QT syndrome does not cause anxiety (except when people on internet forums try to diagnose you with it).

So I'm going to have to agree with en forme de poire here that we ought not be talking about zebras when hearing these particular hoofbeats.
posted by treehorn+bunny

A 2000 review article I found at the NCBI put the incidence of inherited long QT syndrome at 1 in 7000 in the US. However,

Acquired LQTS is much more frequent than the inherited form, but accurate estimates of the frequency are unavailable. The most common cause is medication induced. Perhaps the initial recognition of this problem was the description of "quinidine syncope and sudden death" [57]. Since then, many medications, and also illicit drugs, have been demonstrated to have this adverse property. A number of medications have been withdrawn from the market, most notably perhaps terfenedine in 2000 and cisapride in 2001, amongst a lot of publicity and concern by physicians and medical organizations, the pharmaceutical industry, the FDA, and the legal profession. Currently, more than 50 commonly prescribed medications cause QT prolongation and/or have been associated with torsade de pointe or sudden death. In order to help physicians and other providers, as well as patients, know which drugs have this effect, they can be viewed on the web at www.qtdrugs.com and www.sads.org. The risk of acquired LQTS from these medications varies widely, ranging from well less than 1% of patients to whom the medication is given, to over 10%. While, on average, the risk is very low, some of the drugs are prescribed for many millions of patients each year. Consequently, the cumulative risk can be high enough to pose a substantial public health risk, e.g. terfenedine and cisapride.

And as the Wikipedia page I linked above states, cipralex is one of the medications associated with long QT syndrome:

Citalopram and escitalopram are associated with dose-dependent QT interval prolongation and should not be used in those with congenital long QT syndrome or known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval.

Also, long QT syndrome does not cause anxiety (except when people on internet forums try to diagnose you with it).

Did you bother to glance at the article abstract I linked in my first comment, treehorn+bunny? I'll save you the trouble, this time:

Increased QT variability in patients with panic disorder and depression.

This study investigated beat-to-beat QT variability in patients with panic disorder and depression, and normal control subjects using an automated algorithm to compute QT intervals. An increase in QT variability appears to be associated with symptomatic patients with dilated cardiomyopathy and also with an increased risk for sudden death. QT(vm) (QT variability normalized for mean QT interval) and QT(vi) (a log ratio of QT variance normalized for mean QT over heart rate variability normalized for mean heart rate) were significantly higher in patients with panic disorder and depression in supine as well as standing postures (P=0.002 and 0.0001 for QT(vm) and QT(vi), respectively). In another analysis, QT(vi) was significantly higher in patients with panic disorder compared to control subjects in supine as well as standing postures during spontaneous breathing as well as 12, 15 and 20 per minute breathing (P=0.005). ...

A 2004 article on effects of hyperventilation on heart rate and QT variability states that

Panic disorder is associated with an elevated risk of cardiovascular disease and sudden death. Individuals with panic disorder have been shown to have reduced variability in heart rate and increased variability in the QT interval on electrocardiogram (ECG), patterns predictive of sudden cardiac death in certain forms of cardiomyopathy. ...

I'm glad to hear you stopped taking the cipralex, Dynex
posted by jamjam at 10:08 PM on May 18, 2013

If you are really freaked out about long QT syndrome, EKGs are very easy and noninvasive tests. However, OP did not have panic disorder (generalized anxiety isn't the same thing), and most importantly, did not appear to have heart palpitations, arrhythmia, or fainting, so I severely doubt it would be worth it. (Besides, empirically, SSRIs do not have a high risk of serious cardiac side effects.)
posted by en forme de poire at 10:50 PM on May 18, 2013