QUESTION:
Dear Dr. Heller,
Hi there. I have a question for you. In mid-November my sister was diagnosed with colon cancer which has metastasized into her liver. Needless to say, since I am close with her I was upset at this news. I have always been a worrier but have not experienced any sleeping disorder or anything since 1994. This is what happened: I was sad to hear of my sister and at the end of December 2000 my husband went on a vacation that had been planned prior to hearing of my sister's illness, and I was home alone. I began to look up on the Internet everything I could about colon cancer metastasizing to the liver (almost was obsessed with finding something), and I would relate it to my sister.
I called friends and told them of my sister's illness and was crying - I was always able to fall asleep at night. I would cry during the day at work and became sad. I guess I didn't think I should be happy because my sister was sick, but I wasn't anxious or having a sleep problem. I have always been concerned regarding my health, and if something isn't right I go to the Doctor and sometimes get anxious over that. Well, I had some aches and pains and the two days before I went to my Doctor I got myself all worked up that something major bad was wrong with me. When I got to the Doctor's office I told him about my sister and said I thought the scar tissue in my lower right side of back was something other than that. He assured me it wasn't anything but scar tissue. But because my blood pressure was up that day and it's usually low I asked him for something to help me with this. He told me to take the 10mg Paxil samples, one per night. I'd taken this in 1994 after my hysterectomy and it made me feel great.
Well I took 10mg that night (last time I'd taken 20mg once per morning) and I woke up in the middle of the night with these burning sensations on my arms/legs/scalp and I could not fall back to sleep - every time I laid down in the bed I got the burning sensations. I called him and he gave me Ambien which helped somewhat. I took the Paxil 10 days and then quit taking it. Then Zoloft - increased after 1 week to 50mg. The Zoloft gave me the same burning sensations and the anxiety was horrible - worse than anything I've ever experienced. So I went to see a psychiatrist who suggested Remeron because from what I'd told her she thought I had generalized anxiety, and I began taking 15 mg for 3 nights on March 5. I increased to 30mg on March 8.
I am still sleepy in the mornings and am that way until about 2 p.m. I keep asking my psychiatrist if she still thinks I need to be on anything. Although I was anxious over my sister I had no problems sleeping, and was sad - she says yes she still thinks I am an anxious type and could benefit from this medication. Everyone tells me that the side effects of the Remeron (sleepiness/foggy/dizzy/spacey feeling) go away after about 3 weeks and I was wondering if that's true. I've spoken with a few people on the Internet who have used the medication and this is what they all say too, but wanted to know if you could confirm this.
I take my pill at 9 p.m. and go to bed at 10 p.m. and at 6 a.m. I am really tired and it's so hard to get out of bed and make myself go. I drink coffee which helps some but I've been for the past 10 days on 30mg. I have still found myself to be groggy until 2 p.m. Do you think this will go away, do I need to be on any medication? My psychiatrist said I could experiment and go off all the medications for 4 days. It should be out of my system and see how I feel, but I am afraid that the people (my bosses) at work will shoot me for going off everything because I went through such a bad spell with the Paxil/Zoloft. Also she said I could try going to 45mg but I wonder if 2 weeks of the 30mg is long enough of a trial to see how it works.
On Friday (3/16) I took the pill at midnight and slept until 8 a.m. on 3/17. I couldn't get out of bed until noon on 3/17. On 3/17 I took the pill at 11:30 p.m. and probably went to bed at 12 midnight and got up at 8 a.m. on 3/18 and didn't feel too bad or spacey. Then on 3/18 I took the pill at 9 p.m., went to bed at 10:30 and slept kind of where I was, waking up throughout the night, and on 3/19 I couldn't get out of bed at 6 a.m. I found myself sleeping untill 9:30 a.m., then I made myself get out of bed. I was spacey/dizzy until 2 p.m. or so.
Does the Remeron actually and really get better, and do you lose that dizziness/spaciness? I find that it's helped my anxiety but I still get that feeling of tightness in my throat. I went from being a happy person (a worrier and somewhat bored) to being a person that was sad, cried over her sister's illness but yet could sleep, to a person that was nervous, anxious, couldn't sleep and almost couldn't go out of the house even to get a haircut, and became very nervous at work and home. I can't believe what's happened to me. Everyone says the Remeron will kick in and I'll feel better and the sleepiness will go away.
Please help and answer.
Thanks.
ANSWER:
For most the side effects are gone in 2-3 weeks. Just as important, however, is BuSpar.
You have the generalized anxiety disorder which also needs to be treated. You are also
depressed.
SSRI medications like Paxil and Zoloft will worsen the generalized anxiety disorder.