Should I cut my losses and ditch the meds?

[recoveringyogi]

Hi everyone! I'm new here and I feel like I'm at the end of my rope with medication at this point.

Some background information: (You don't have to read this, but it helps :)) I suffer from Generalized Anxiety Disorder and depression comes secondary to it, as in "anxiety kicks my butt some days." I had been doing very well in managing my anxiety for a few years, didn't go to therapy (big mistake), and got off of my Lexapro (which worked wonders & was god-sent) for the 2nd time last year and had a relapse in December. The reason: I started getting vertigo, which I learned was I byproduct of my migraines after 7 months of ridiculous medical testing. I knew it was nothing serious. I just wanted to know what it was so I could work towards relieving it. And, it passed. My anxiety stuck around, though, mainly because of bad timing and poop circumstances/bad mental habits.

In the past 11 months, I have tried a handful of meds to no avail. Lexapro stopped working for me the 3rd time around and actually made me worse. I stayed on it for 8 weeks before deciding it wasn't working. I tried Prozac for 5 months and, at the same time, starting taking Klonopin (.25mg once daily, which was basically nothing.) It was IMPOSSIBLE to get off of that tiny dose of Klonopin after 2 months on it, which made me realize that the Prozac probably wasn't doing anything for my anxiety. Previously, I have cold-turkeyed (bad idea) off of Klonopin after a few months-a year and was just fine because Lexapro actually worked. I'd get rebound anxiety for a few days-weeks but it'd go away and I usually dealt with it just fine. My max dose ever on it was 2mg. I felt better OFF of both of those meds. I tried Zoloft but started having weird neutral-and-down mood swings on it (not bi-polar styled mood swings by any means.) once I got to the therapeutic dosage, so my psychiatrist said not to even bother with it anymore. 3 SSRIs down, 3 to go.

We decided, next, to try Effexor, which worked really well, but eventually made me feel numb and exacerbated my migraines (which were very well-managed thanks to the preventative medication that I take for it). Instead of having 1-2 a month thanks to my Propranolol, I was having 1-2 a week, and mine typically last for 72 hours. It also disrupted my sleep. I was on Effexor for 6 weeks and we tapered me off of it. WITHDRAWAL WAS HELL, side note. I tried Cymbalta next, but it was giving me the spins SO bad, and the side effect seemed to be getting worse instead of easing up. Did not do a dose increase whatsover. I could barely drive and it was driving me nuts. I laid in bed crying for 2 days because I was too dizzy to function. I'm now off of Cymbalta after 8 days.

To summarize, I've tried: Lexapro, Prozac, Zoloft, Effexor and Cymbalta.
Lexapro the third time around, Zoloft, Effexor and Cymbalta hurt more than they helped.
Prozac didn't do squat. It didn't help, but it didn't hurt.
I'm still on Klonopin: .25mg 3x a day. (.75mg a day). It works wonders, but doesn't eradicate my anxiety. It just makes me feel more separate from it so I can handle it better, which is what Lexapro used to do for me.

I want to get off of the Klonopin so badly, as the tolerance aspect scares the life out of me.
I used to be fine taking .25mg once a day. I'm now up to .25mg three times a day.
I've been working with a phenomenal therapist, as well, and in group therapy 4x a week.

Basically, what I'm getting at here is: What should I try next? I'm at a complete loss. The only 3 SSRIs I haven't tried are Celexa, Paxil and Luvox (which my pdoc told me is mainly used for OCD). He won't put me on Paxil because of the weight gain side effect (I used to struggle with an eating disorder as a teenager.) We're unsure if Celexa would work because it's *closely* related to Lexapro, but not the same. SNRIs are totally out of the question now.

I haven't tried BuSpar but I don't even know if that'll work without the classic "anti-depressant." My neurologist says I can't take TCA because of the type of migraines I am speculated to have. TCAs are used for migraine abortion/prevention, too, and she warned that they may cause stroke. I can't explain why, as I'm not a neurologist. I refuse MAOIs because you basically have to restrict all aspects of life. I've looked into Lyrica and Gabapentin but don't know much. Again, end of my rope. Meds are causing me more anxiety than my anxiety is! What a change.

Has anyone had a similar experience and finally found a medication that WORKS? This is kind of a bummer considering Lexapro worked SO well for me in the past.

[Paxiled]

If you want to stay on meds, I'd give celexa a try precisely because it is so close to Lexapro but different.  It has different side effects and doesn't work exactly the same, so it might bypass the resistance you're brain has worked up to Lexapro.  If it doesn't work if you stop it soon you probably won't have a bad withdrawal.  This was something my psychiatrist tried with me when Lexapro didn't work because of a rare never-ending withdrawal from Paxil -- she felt I could handle it easily because they were so similar.  For me, neither worked, but it does say that at least one psychiatrist who is a psychopharmacologist thinks they're different enough to be different drugs, but for you close enough to maybe work as Lexapro once did.  Paxil is hell to stop taking, and Luvox probably is too.  I don't think your doc is right about Luvox, though -- although it did some trials to get approved in Europe to treat OCD, which no other antidepressant had done at the time, it's just another ssri and does everything any ssri does.  Problem is, it has a lot of contraindications with other drugs and has a very short half-life in the body, which probably means bad withdrawals.  It just isn't that well-known in the US because it never marketed itself here and so it just isn't used much here; it's mostly used in Europe.  But I think the main question for you is, how well are you functioning?  If you're doing what you need to do every day, then maybe it's time to give your whole self to therapy, probably CBT, and see if it works for you.  If it does, which isn't guaranteed, then you're actually cured, whereas drugs will always just be a palliative.

[Paxiled]

I meant to also say, I used to suffer from migraines until a doctor told me to try TM, a form of meditation.  That was several decades ago, and I've had three migraines since.  Migraines are basically a gathering of blood in the blood vessels near the head while the external blood vessels are constricted, pushing all the blood up there.  If you can even out the blood flow through meditation, exercise, eating right, or biofeedback, you can beat it without drugs.

[recoveringyogi]

Thanks for your input! I may give Celexa a shot. I'm basically just trying to do the "find an AD that works for my anxiety so I can get off of the Klonopin." If I don't take it, I get some pretty wicked rebound anxiety along with depression, though it works pretty well. I just don't wanna rely on a benzo by itself. Taking Effexor helped me get off of 1/4 of the dose I was taking, which was hopeful considering I remember when trying to taper off of it while on Prozac, I was hiking and saw a deer and it scared the life out of me. It's strange because I love animals. My anxiety was through the roof. On Effexor, I just got physical symptoms of anxiety when tapering off the kpin which I was too numb to notice. Anyway, I am basically exercising every other day, practicing yoga, mindfulness, going to therapy 5x a week, eating pretty healthy, doing everything I can, and while those work, I feel like meds can really augment therapy. They've always helped in the past but trying 4 new meds is ridiculous at this point. I can function rather well as in "do what I need to do to get by" but my quality of life is so low due to how much anxiety truly affects me. I took a semester off from college and I'm now taking a break from my yoga teacher training. It gets so bad somedays (such as today) that it spins me into this hopeless depression. I know he'll probably try Paxil as a VERY last resort. It its WD is anything like Effexor's, I can see why he would. I'm calling him today and also probably talking to the therapist about Celexa. I work, which keeps me sane, but I can't keep living like this. Everything changed when I relapsed.

[recoveringyogi]

Another thing, which baffles my primary care doctor, is that my health is actually so good for someone with GAD. My resting heart rate is 70bpm usually. When i was hospitalized, it was 50-something and the staff looked at me like "how are you so anxious but so healthy?" I also sleep pretty well! I've exhausted everything I can actually control. Talked to my friend about it last night and he said I seem to be doing better but most of that is because I'm in intensive therapy and on Klonopin. He said "nix the antidepressants" but truly I can't control or change how meds react to me. Effexor was the only one that worked but the side effects while on it were really messing with me.

[Paxiled]

It's the yoga and the meditation and the exercise.  I have the same thing -- anxious beyond belief and low blood pressure and slow heart rate.  Everyone is different and we all manifest our problems differently.  The Effexor should have made you more anxious; if it didn't there might be depression going on you haven't addressed.  As for quitting klonopin, that's as bad or worse than quitting Effexor or Paxil, the two worst antidepressants for stopping.  Benzos are addictive and very tough to stop because regular use can prevent the brain from learning how to adapt to stress.  It should be a slow process, not something done quickly -- as long as it takes.  There's no rush.

[recoveringyogi]

Yes! I knew benzos prevented some kind of learning. I'm somehow magically withdrawing from Cymbalta (after 7 days of being on it...???) and I'm pretty sure the Klonopin isn't doing much considering my nerves are through the roof the past few days. The WD rebound anxiety is pretty strong. Effexor made me jittery the first four days or so - most stimulation AD to date - but I ended up feeling really numb on it, which definitely took the edge off of going from 1mg to .75mg of Klonopin. It was impossible on any other med. But, my gosh, that withdrawal. After 1 1/2 months: AWFUL. I can't even imagine how Paxil was in comparison. I've read some people withdraw from Paxil for 18-ish months or more. I do have depression secondary to my anxiety (which is purely GAD so it doesn't discriminate what i'll worry about.) I had two "true" major depressive episodes (2+ weeks) but it gets easier to manage. SO much therapy and hospitalization helped that one. Talked to my psychiatrist and he's sending Celexa my way on Monday. SSRIs seem to give me the least bothersome side effects, short and long term. The worst was 2 weeks of nausea with Lexapro and I just drank ginger tea for that! Then fatigue most of the time I was on it, but coffee and strategic naps nixed that one.