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>> No. 3741 Anonymous
15th February 2016
Monday 4:04 pm
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I've suffered from both chronic anxiety and chronic pain for years and have recently managed to get a stable care plan in place as well as a combination of meds that work for me most of the time.

Dihydrocodiene for the immediate pain, Diazepam for the spasms caused by the pain and also for the worst symptoms of the anxiety and amitriptyline for the Neuralgia and also to help me sleep at night.

My anxiety has flared up quite bad recently though and they can't up my dosage of diazepam to get a handle on it as apparently they aren't allowed to and only specific conditions can receive stronger than 2mg doses and anxiety isn't one of them (With the exception of a fear of flying, they'll give you 5mg. I assume you have to be epileptic to get 10mg.), so I was given an SSRI called Sertraline by the doctor to help manage it instead. I started the course today and within 20 mins I was somewhat regretting it. I felt a wave of what can only be described as numbness wash over me. I no longer feel anxious, but I feel thick like I can't think. My lids are heavy, to be honest I feel like I'm heavily sedated, and I have a weird sharp stabbing pain behind my right eye. I have been on opiates and benzos for so many years that I'm intimately familiar with their side effects and the reason I mentioned them before was so I could give you a picture of what I'm on and rule them out, because I don't think it is them and also, now that I think on it, I haven't even taken any today so it can't be them.

Do any of you lads have any experience with drugs of this nature, or even just this one in particular? Is this just par for the course with SSRIs or should I consult the doctor and stop taking them? Panic attacks are shit and everything and I have crippling agoraphobia, but I don't think making me feel like this instead was what the doctor had in mind when he said he wanted to get my anxiety under control.
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>> No. 3742 Anonymous
15th February 2016
Monday 8:46 pm
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Caveat: I'm not a doctor, just a mentally ill nerd. Don't take anything I say as gospel truth.

Sertraline is the default SSRI because there is a good evidence base across a wide range of conditions, the risk of serious side effects is relatively low, it is well tolerated by most patients and it costs pennies.

There is a very long list of alternatives that you might get on better with. If you go back to your doctor and say that you're not doing well on sertraline, they should offer an alternative drug. You might also want to consider the timing of your dose - sertraline should be just as effective if taken at night, but the side effects may be much less of a problem.

In your case, interaction between your medications is likely to increase the risk of some side effects and make prescribing more difficult. I'd be slightly concerned about the interaction between amitryptiline and sertraline, as there is a risk of serotonin syndrome. If at you feel extremely hot and agitated, you should stop taking both drugs and seek immediate medical attention.

It might make sense to try switching the amitryptiline for an SNRI or an anticonvulsant. Several drugs are effective for the treatment of both neuropathic pain and anxiety, so you may be able to kill two birds with one stone. This would reduce the risk of side effects from drug interactions, but your neuralgia symptoms might briefly increase while you're switching drugs. Duloxetine or pregabalin would be plausible options. If you think this might be worth trying, discuss it with your doctor.

We don't really understand how or why antidepressant drugs work, so there's a lot of trial-and-error involved in prescribing. Most antidepressants can cause either drowsiness or insomnia depending on the patient, which is just weird. There's also an element of matching the right side effect profile to the right patient. Some side effects can be beneficial to some patients.

If want to swot up, you can read the NICE guidelines for Generalised Anxiety Disorder at the link below. These guidelines are the standard treatment approach that doctors are expected to follow. The guidance for drug treatment starts at paragraph 1.2.22.

>> No. 3743 Anonymous
15th February 2016
Monday 8:51 pm
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> I felt a wave of what can only be described as numbness wash over me. I no longer feel anxious, but I feel thick like I can't think. My lids are heavy, to be honest I feel like I'm heavily sedated...

Yep that's an opiate painkiller alright, the dihydrocodiene hard at work. It really does feel quite different to a benzo, doesn't it? You'll eventually build tolerance to the 'fun' (I personally never liked opiates) side effects but it might take you a while.

On a side note 2mg of diazepam is a pitiful dose for panic attacks, 5mg being bare minimum and while I'm at it diazepam is practically useless for epilepsy - 2mg of clonazepam will do the trick far better than even 20 or 30 mg of diazepam for treating seizures. I know doctors are trying to reduce benzodiazepine abuse by pushing SSRIs in their place but treating acute panic attacks with something which, at best, might treat day to day background anxiety is a road to nowhere.

Finally you might want to put threads like this in /A/ in the future as people have been known to throw shit-fits for any kind of 'drug' talk on other boards.
>> No. 3744 Anonymous
16th February 2016
Tuesday 12:15 am
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Considering the last time I took a painkiller was the night before, they really must be belters.


Thanks for this info, lad. Really good post, I appreciate it. I'll give it another try tomorrow night and if I'm OK in the morning I'll perhaps reconsider. You've given me some homework to do as well, so thanks. I have another appointment in 2 weeks so I'll have a chat with the doctor about it then if I feel it's still making me feel horrible and discuss alternatives.
>> No. 3746 Anonymous
16th February 2016
Tuesday 12:45 am
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> Considering the last time I took a painkiller was the night before, they really must be belters.

Apologies lad as I may have misunderstood your post. When you said "I started the course today" I assumed that you'd only started taking the dihydrocodiene today too, not just the sertraline; I therefore put two and two together and apparently came up with five. I have no real personal experience with sertraline but I hope you get whatever the problem is sorted out.

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