Question:
Hello sir,
I wondered if you might answer the question of how a person would know if they are exhibiting GAD reactions to an SSRI, or whether it might be a slight hypomanic or manic reaction? I ask this because I am on just 20 mg. of Celexa, and I tried to elevate to 30 mg. One night, by taking a full 20 mg. tab. before bed, I felt very hyper and wired, with a very difficult time falling asleep. I am taking this primarily for OCD, but I question the diagnosis that was made of this. It seems to me that this Celexa is actually accentuating the OCD some days. But, I believe it to be some other anxiety problem too, because just .25 mg of Xanax at night, taken with the Celexa, makes me feel great. I don't feel the OCD as much, and the anxiety is diminished too from the Xanax.
I am on just 15 mg. of BuSpar in the morning, and I attempted an elevation to 30 mg.--with no success. I felt very moody when I raised BuSpar up, and I felt actually more anxiety.
Can you explain these reactions to me? You have told me in the past that I might have PTSD problems, and I think I agree. But, doesn't that have to be a life or death situation to bring that on? I was in a relationship a few years ago, and it was a nightmare. Ever since then, I have never been as right as I was before that. But, there was not any real physical violence either way. Just an insane amount of verbal abuse and constant degrading and insulting on this girl's part, which seemed to leave a permanent impression on me. This is why I obsess so much before going out to a bar. It seems that I can't reason that not every woman will pick my appearance apart like this girl did. The sad part is that I am a very attractive guy to almost all women I know and meet. But, I have this chronic low self-esteem that seems to always be there and cause me to obsess over my appearance. I feel like just elevating my Xanax to a higher dose, or asking to add something like Depakote, just to slow down my nervous system, which seems way to overactive. But, I realize that an elevation of Xanax will likely depress me, and make me need more down the road, and I don't want that.
Lastly, I should mention to you, I will have a few good days where I feel pretty good. Not very obsessive. Pretty calm. Decent self-esteem. Happy. Then, it seems to switch to like 3 or 4 days of very high obsessive and compulsiveness,anxiety, chronic low self-confidence, depression, high-strungness, etc. I feel that I have still way more of these type of days than good days.
Sound like a pattern to you? Or anything that might not have been identified?
Dr. Heller's Answer:
You likely do have both the GAD and PTSD (or at least an elevated serotonin 2 receptor). The GAD is always present, usually with persistent worry. It is usually worsened by SSRI medications like Celexa. Generally when BuSpar causes anxiety that serotonin 2 receptor needs to be lowered with Remeron (at least temporarily).
Many individuals have experienced an improvement in self esteem and rejection sensitivity from Prozac.
Anxiety symptoms can come and go.
PTSD symptoms do not require a life and death situation to be present, any significant emotional or physical trauma can cause some symptoms.
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