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whoknew: PGAD caused by SSRI - will another one do the same?


whoknew

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Hi everyone,

 

I'm new around here. From looking through the archives, it seems like a few of you have had the unfortunate experience of PGAD that began shortly after beginning SSRIs. I'm in the same boat. I begin Lexapro (escitalopram) 5mg in November, and after 4 days, I experienced a sudden onset of PGAD. I immediately stopped taking the Lexapro, and now (3 months later), the PGAD has definitely lessened, but it's not totally gone. It's manageable at this point, and I feel like it will probably continue to fade over time, but man it was really, really awful when it was at its worst. Difficult to function with it.

 

The problem is that the depression, anxiety, and OCD for which I was originally prescribed the Lexapro are slowly worsening. I've tried everything.  Cognitive behavioral therapy (been going steadily for 2 years), exercise (intense exercise 3-5 times a week, every week, for the last 2 or 3 years), meditation/mindfulness, yoga, "positive thinking", clean eating, no caffeine, no alcohol, etc... and despite it all, I can feel myself slipping deeper and deeper into the darkness.

 

The doc who prescribed the Lex gave me Wellbutrin to try when the Lex didn't work out, and that was a nightmare for me. I was on it for about a week but I experienced anxiety, panic, depersonalization, and obsessions so bad that I really thought I might harm myself just to escape the hell. I knew you're supposed to wait those things out for 2 weeks to see if the initial side effects "settle down", but I was truly worried about my safety.

 

My question is, has anyone ever experienced PGAD from an SSRI, and then tried a different SSRI with success? I'd like to try a different one to see if it can help lift this depression, but I'm terrified of the PGAD coming back full force. At this point, I'd be willing to put up with most of the crappy SSRI side effects and the possibility of discontinuation syndrome to have the anxiety and depression fade somewhat, but the PGAD made it impossible to sleep or focus on work.

 

I know everyone here is generally anti-pharmaceuticals, which I totally get, given how bad some of the drug experiences can be. I'm just feeling totally out of options.

 

Thanks for your help and support.

- Several years of depression and lifelong anxiety and OCD, varying severity over time

- Tried 4 days of Lexapro, triggered PGAD, which is slowly improving over the last 3 months

- Tried 1 week of Wellbutrin which caused severe panic and derealization/depersonalization

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  • Moderator Emeritus

Hello whoknew,

 

It's true, we don't ever recommend drugs here.  There are many reasons, but one is that once your Central Nervous System has become destabilised by drugs, it is highly likely to react badly - or even worse than previously - to any others that you try.  It's because their effect is cumulative.  Each drug change you make just adds in another layer of instability. 

 

Another important thing to know is that antidepressants (insanely, perversely) actually cause depression and worsening anxiety, besides other things.  We can help you look at other options.  Your story has some basic similarities to my own - particularly the aspect of trying so many things, and for so long, in order to try to manage depression etc.  I eventually got desperate and ended up on SSRIs.  Sounds like you reached the same point. 

 

Is this summary right?  3 months ago you had 4 days on lexapro which caused an adverse reaction of pgad.  Then wellbutrin for a week, again with awful side-effects.  Considering your reactions, I'm thinking that reinstatement - even of a tiny amount - is not a good idea (but if a more senior mod thinks differently we can look into it). 

 

Time might be your healer, along with being very determined not to further complicate things with more drug use. 

You may like to try Fish oil and Magnesium which many people find useful during withdrawal.   

Keep it Simple; Keep it Slow; Keep it Stable

Non-Drug Techniques to cope with emotional symptoms.

 

Please put your withdrawal history in your signature – all drugs/dates/dosages etc - so we can see your situation easily whenever you post, and help you more accurately.  Thanks.

 

Have a read of those and then you can come back to this thread to discuss things further.  This can be your journal to record your tapering and healing progress, and to ask questions. 

 

Welcome to SA,

Karen

2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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Hi whonew,

Your story sounds almost exactly like my story.

You had a bad reaction to Lexapro after only after 4 days.

I had a bad reaction to Zoloft after 3 doses and experience PGAD for a while.

The PGAD symptoms will go away eventually, but like you I slipped into a really dark place, when PGAD symptoms occurred.

You are obviously sensitive to Lexapro and possibly other SSRI's.

My advice to you is to stay clear from SSRI's as it could flare up PGAD symptoms and make it even worse.

I have anxiety and some OCD tendencies and after I took Zoloft, I experienced such depression to the point where I did not want to live anymore.

I completely understand where you are coming from. But rest assured that it does get better.

Are you experiencing crying spells, weird head feeling, burning sensation in your arms, chest, exreme anxiety, burning feeling in your mouth, burning feeling and pain down below?

Doctors are clueless and will mostly say to you that they have never heard of PGAD being caused by SSRI'S.

Be careful with suppliments as I found out that it can flare up PGAD symptoms.

It does settle down but it does take a while. Don't be disheartened.

Were you depressed before you took Lexapro? Or did you experience severe depression after Lexapro?

It is worth getting a pharmocogenic test to see if you are poor metaboliser and to see what other ADS you could be sensitive to. It does not guarantee that SSRI's you are not sensitive to will work for you.

When I did the test, it showed that I was sensitive to Zoloft, Lexapro, Celexa, etc.

Please think carefully before adding anymore drugs to the mix.

You will recover from this, but the best way forward is to educate yourself, to take care of your self, not to blame yourself, to accept your current situation, (which I know is hard), and to take each day as it comes.

I know exactly how you feel, I have been in your position, but things have improved.

Take care, don't loose hope, because hope will get you through this difficult time. Blessings to you, Hopefull.

DRUG HISTORY:

 

November 2013- Zoloft, ( Bad reaction).

January 2014 - March 2014 Seroquel.( Quit Cold Turkey).

January2014- Mirtazapine, I was taking 15mg at one stage, reduced to 7.5mg, Pgad reactions to Mirtazapine. Doctor kept increasing it to 37.5mg, until July 2014. No improvement, experiencing panic attacks, on 37.5 mg. I had enough by October 2014. Began tapering.

October 2014- Started tapering Mirtazapine from 37.5mg.

September 2015- Down to 4mg of Mirtazapine. Crashed.

September 16th- Up dosed to 5mg. Held this dose for almost 5 months. Stabilised.

February 2016- Began tapering again. From 5mg to 4.5mg of Mirtazapine. (Rocking the boat, again)! Lol. :(

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  • Moderator Emeritus

Excuse me interrupting here - just wanting to thank Hopeful for writing such a beautiful and hope-filled post. 

2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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Thank you,Karen. Hope is all we have. :)

DRUG HISTORY:

 

November 2013- Zoloft, ( Bad reaction).

January 2014 - March 2014 Seroquel.( Quit Cold Turkey).

January2014- Mirtazapine, I was taking 15mg at one stage, reduced to 7.5mg, Pgad reactions to Mirtazapine. Doctor kept increasing it to 37.5mg, until July 2014. No improvement, experiencing panic attacks, on 37.5 mg. I had enough by October 2014. Began tapering.

October 2014- Started tapering Mirtazapine from 37.5mg.

September 2015- Down to 4mg of Mirtazapine. Crashed.

September 16th- Up dosed to 5mg. Held this dose for almost 5 months. Stabilised.

February 2016- Began tapering again. From 5mg to 4.5mg of Mirtazapine. (Rocking the boat, again)! Lol. :(

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Thanks so much for your responses, I really appreciate it. I've updated my signature with my history now, and I think it should be working - sorry about that.

 

Hopefull, I read your thread about your experience with PGAD, and it really did give me a lot of hope. I am happy to say that 3 months out, my PGAD symptoms are generally 1-3 out of 10 most days, when they were initially something like 8-10 out of 10. I am encouraged by your experiences and with my waning symptoms that it will go away. It's honestly manageable now and not something I think about other than as a minor annoyance.

 

I agree that I am probably sensitive to the SSRIs. I'm still not sure what my next step should be to address my depression.

 

To give a bit more history, I've successfully dealt with the anxiety, OCD and mild depression without drugs for many years. I've used many of these non-drug techniques along with cognitive behavioral therapy ,and have generally got through it pretty well. But over the last year or so, things started deteriorating with my mental state. Panic attacks crept in out of no where, and depression started to fog my days into a grey slog. My OCD often manifests as harm OCD, and the increased depression made me begin to obsess about suicide and constantly scan/"check" for suicidal thoughts. (To be clear, it wasn't that I wanted to kill myself, but I was obsessively worrying that I would become suicidal, which made me scared that I was suicidal, which increased the checking behaviors - gotta love the endless loop of OCD). I'm not sure why all this happened after years of successfully keeping my mental state relatively healthy without drugs. When I realized things weren't getting better with the non-drug coping techniques, I elected to start the Lexapro. That was in early November.

 

Then the PGAD happened after only 4 days, which was so devastating, because I really hoped the Lexapro would help me out of my depression. I never had a chance to find out if the Lex would help or not, because of the stupid PGAD. Hopefull, I also had the experience of doctors telling me I was crazy for thinking my PGAD was caused by the SSRIs. I am a professional scientist, and I thought if I brought in printouts of peer-reviewed medical journal articles describing case studies of SSRI-triggered PGAD, my psych nurse would listen. She wouldn't even look at the articles I brought in, and told me I probably had a bladder infection. Mistaking PGAD for a bladder infection is completely ridiculous for anyone familiar with PGAD symptoms. She said wouldn't treat me any more until I went to my GP to get treated for my bladder infection, so I went to my GP and - big surprise! - no bladder infection, of course. GP told me to go to my OB-GYN, and fortunately he is actually familiar with PGAD and was sympathetic. He referred me to a pelvic floor doctor, who gave me some exercises that help a bit with the PGAD symptoms. What a roller coaster. As I said, though, the PGAD seems to be resolving on its own.

 

I finally went back to the psych nurse, who prescribed the Wellbutrin, which I later found out is generally contraindicated for OCD and anxiety. I took it for a week. It basically put me in a constant panic state, where I felt total derealization/depersonalization, and my OCD went crazy. I'd get stuck in mental loops and was unable to focus on anything, even watching a silly TV show or something. That was really hellish, and it took me almost a month after stopping to feel 'normal' again. I started the Wellbutrin in early December, so I'm about 2 months off of any meds now.

 

It's difficult to compare my own mental state to that of the past, but I'd say other than the remnant PGAD symptoms, I think I'm pretty much back where I was before I started the Lexapro - which is to say, stuck with moderate (and slowly deepening) depression and OCD/anxiety/panic. If anything, it was the Wellbutrin that left me feeling worse for the wear. I feel almost traumatized by my experience with it. The 4 days of Lexapro didn't seem to do anything other than trigger the PGAD.

 

I tell myself that maybe it would be different with a different SSRI - they each have different affinities for different receptors and maybe some other SSRI wouldn't trigger the PGAD for me. Of course, I am scared of the PGAD returning, or the SSRI making the depression worse, or suffering some of the long-term bad effects other folks seemed to have experienced. I just feel desperate, like I can't continue slogging through my days like this. 

 

Hopefull, how did you get the drug sensitivity test? Is that something a regular GP can give?

 

Thanks so much for y'all listening. It helps to know I'm not alone in this mess.

- Several years of depression and lifelong anxiety and OCD, varying severity over time

- Tried 4 days of Lexapro, triggered PGAD, which is slowly improving over the last 3 months

- Tried 1 week of Wellbutrin which caused severe panic and derealization/depersonalization

Link to post

Hi whonew,
I just typed a response and it disappeared. :( I hate when that happens.
You can ask your PDOC to have the pharmocogenic test done.
I don't think that GP'S can do that test.
It is a simple blood test.
If I was you, I would not try anymore SSRI'S. You could destabilise your self even further. After Zoloft, I took Seroquel and Mirtazapine, and 26 months later I am still tapering Mitrazapine.
Do you really want to go through that process? You could gain weight snd all the other BS that come with these drugs.
It is entirely up to you. Just remember that most psychiatrist are ignorant and are more than happy to prescribe pills.
You become their slave and a slave to the pharmaceutical companies.
What ever you decide, have a good think.
Give your nervous system time to heal before deciding to try another antidepressant. Many people have been screwed up, by becoming guinea pigs to PDOCS.
Be careful, don't make the mistake that I have made.
Take care, Hopefull. :)

DRUG HISTORY:

 

November 2013- Zoloft, ( Bad reaction).

January 2014 - March 2014 Seroquel.( Quit Cold Turkey).

January2014- Mirtazapine, I was taking 15mg at one stage, reduced to 7.5mg, Pgad reactions to Mirtazapine. Doctor kept increasing it to 37.5mg, until July 2014. No improvement, experiencing panic attacks, on 37.5 mg. I had enough by October 2014. Began tapering.

October 2014- Started tapering Mirtazapine from 37.5mg.

September 2015- Down to 4mg of Mirtazapine. Crashed.

September 16th- Up dosed to 5mg. Held this dose for almost 5 months. Stabilised.

February 2016- Began tapering again. From 5mg to 4.5mg of Mirtazapine. (Rocking the boat, again)! Lol. :(

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  • Moderator Emeritus

As you know, dealing with depression is never straightforward.  For myself it involved a lot of years of work with a good counselor, as well as employing a large range of non-drug techniques.  (My whole story is in my blog, for which the link is in my signature). 

 

Bruce E. Levine (a clinical psychologist) wrote "Depression is simply one of many human 'strategies' to shut down overwhelming pain.  The price paid for the long-term reliance on depression is that it also shuts down energy, enthusiasm, sexual desire, concentration, memory and other cognitive skills, and can lead to guilt, hopelessness, problems in sleeping and eating, immobilization and thoughts of suicide.

"When we habitually employ a shutdown strategy — rather than healing and resolving the source of pain — we develop a tolerance to that strategy, which means that we need increasingly larger doses of it. Shutdown strategies such as depressions, alcohol, or other psychotropic drugs can create a vicious cycle in which the very strategy used to shut down pain can create more pain
."

 

This makes a lot of sense to me.  Perhaps the weight or pain you have been carrying became too heavy.  Please excuse me if this is off-track - it's really tricky discussing such personal things via the internet.  But I did want to offer a general thought that might help you form your next moves.  You may need a good counselor, to continue discussing things with.  I know some people have had very unhelpful experiences with counselors, so it's worth looking until you find one who can provide the help you need. 

 

Basically you want someone who can help you find ways to carry the load (such as CBT) while simultaneously helping you figure out how to unload the load bit by bit.  Someone you can keep on seeing until you finally feel that things have lightened somewhat.  This can be an on-going process.  Our world heaps us up with crap to carry, and there's no shame in finding help in dealing with it.  I was having counseling from age 19 until 36 or so.  And who knows - I may end up there again if things ever become more than I can work out myself.  That's okay - my path is a healing path. 

 

Also - there's no rush to decide what you want to do.  Let your intuition guide you, and take small steps to feel out different options. 

2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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