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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by NealMcCoy on February 18, 2005, at 0:46:46
I have this indescribable, agonizing feeling in the center of my brain that makes me wish that I were not alive. It is like nothing I have ever experienced in my entire life. I do also have the crawling out of my skin sensation. I took 20 mgs of propranonol and it doesn't seem to be working. I am getting a bit concerned. This feeling isn't anywhere near bearable. It's gotta be the worst feeling known to man..Any comments or suggestions?
Posted by yxibow on February 18, 2005, at 3:14:50
In reply to Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 0:46:46
> I have this indescribable, agonizing feeling in the center of my brain that makes me wish that I were not alive. It is like nothing I have ever experienced in my entire life. I do also have the crawling out of my skin sensation. I took 20 mgs of propranonol and it doesn't seem to be working. I am getting a bit concerned. This feeling isn't anywhere near bearable. It's gotta be the worst feeling known to man..Any comments or suggestions?
You haven't mentioned what medication(s) you are taking that precipitated this sensation.
I've experienced akathisia on a half dozen or so times at least... "skin crawling" is one sensation though at least in my experience it is marked also by an inner sense of either a need to pace or to grope the nearest sofa or carpet with writhing thought.
I cant prescribe by proxy but in my experience a major episode for me usually doesnt go away without 40 or 50mg of propranolol (200mg/day or so is the upper limit of what people take for heart related conditions).
Not suggesting you down that amount of propranolol without observing that your pulse is at least 60 or so, because it -will- lower it and fainting and stopping your heart isn't highly recommended.
Also if nothing else is available to you, and you're ready to hit the hay anyway, 50mg (standard dose) of benadryl OTC (also marked as unisom and other sleep medications... they're all the same and benadryl, diphenhydramine generic is usually cheapest) may hit the spot.
Talk to your doctor about increasing the propranolol dose in general, and/or being prescribed one of the non-drowsy anticholinergics (benadryl is a drowsy one) such as Akineton or Artane.. Cogentin affects cognition more than those but is a common prescription too.
Hope you feel better.
Posted by med_empowered on February 18, 2005, at 7:22:27
In reply to Re: Akathisia, is this it?, posted by yxibow on February 18, 2005, at 3:14:50
hey! You can medicate away the symptoms of akathisia, but I'd seriously recommend either reducing the dose of the med(s) causing it or stopping the med(s) involved altogether. Really, its JUST NOT WORTH IT, and some research seems to indicate that tardive dyskinesia (the dreaded movement disorder caused by neuroleptics) and akathisia may be caused by the same drug-induced brain abnormalities; one study I read showed higher rates of TD in those who exerpienced bad akathisia (which yours certainly is). But...here are some anti-akathisia meds: benadryl, propranolol, and the benzos (ativan and Klonopin are the big ones...it seems as if Ativan is used more often in people with schizophrenia and schizoaffective disorders, while there is a preference for Klonopin in bipolar and other mood-disorders...personally, I say take your personal favorite).
Posted by SLS on February 18, 2005, at 7:37:47
In reply to Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 0:46:46
> I have this indescribable, agonizing feeling in the center of my brain that makes me wish that I were not alive. It is like nothing I have ever experienced in my entire life. I do also have the crawling out of my skin sensation. I took 20 mgs of propranonol and it doesn't seem to be working. I am getting a bit concerned. This feeling isn't anywhere near bearable. It's gotta be the worst feeling known to man..Any comments or suggestions?
What medications are you taking right now?
- Scott
Posted by ed_uk on February 18, 2005, at 9:48:33
In reply to Re: Akathisia, is this it?, posted by SLS on February 18, 2005, at 7:37:47
Hi :-)
Neal sent me a babblemail so I asked him some questions. I hope he will reply soon and tell us more.
When I had akathisia, it would have been completely impossible for me to type a single word so I think he may need to ask a friend to type the answers for him. I'm not yet sure that what he's experiencing actually is akathisia though so maybe I'm being premature in saying this.
Ed.
Posted by ed_uk on February 18, 2005, at 11:32:47
In reply to Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 0:46:46
Hi,
Neal I'm confused, you said...
'Propranonol does treat what you are describing. I suffered from this for weeks and really wanted to end it. I was prescribed this drug at the ER and after 1 pill I felt 100 percent. However, it can take up to a week or two to work for some people.'
But you also said...
'I took 20 mgs of propranonol and it doesn't seem to be working. I am getting a bit concerned. This feeling isn't anywhere near bearable. It's gotta be the worst feeling known to man.'
Is the propranolol helping?
Regards,
Ed.
Posted by NealMcCoy on February 18, 2005, at 12:52:37
In reply to Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 0:46:46
Ed asked me some questions, and it gives an overview of my situation. I am not on an anti depressant, anti psychotic or any other medication except benzo's. That is what makes this situation awkward. I never hear of anyone having akathisia with benzos.
Posted by ed_uk on February 18, 2005, at 13:00:37
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 12:52:37
Hi,
>I never hear of anyone having akathisia with benzos.
In your mail, you said your akathisia was due to benzo withdrawal, is that right?
Ed.
Posted by NealMcCoy on February 18, 2005, at 13:00:47
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 12:52:37
Which benzo were you taking?
-ValiumWhat dose were you on?
-10 mgs daily before deciding to withdrawal.For how long did you take it?
-Took it daily for over 1 year before I started a long taper.Are you still taking a reduced dose of the benzo or have you stopped it altogether?
-I tapered for 6 months and stopped for a week and then took 1 mg last night. It seemed to help a little. It doesn't take much benzo to effect me and that's why this little dosage seemed to hit the spot a little.Are you on any other medication at the moment?
-Just the benzo and the propranonol to help with the akathisia.Have you recently stopped taking any other medications?
-NoWhy were you taking the benzo?
-For anxiety related reasons.Do you have any psych diagnoses?
-No. I was prescribed this drug by a shrink, but never given any diagonosis.
Do you suffer from any medical conditions?
-NoAre your symptoms relieved by increasing the dose of your benzodiazepine?
-I took the 1 mg last night and I noticed a difference. Not 100 percent, but enough to give me some comfort.Why did you stop taking the benzo? (or reduce the dose)
-Tolerance. The medicatin no longer worked and I developed tolerance withdrawal.Did you have any side effects while you were taking the benzo?
-Yes. Increased anxiety, headache, muscle tension, blood sugar problems.Has the propranolol helped at all?
-After 2 days of it, I cannot say it has helped much at all. It did help before, but that was when I was on 5 mgs of valiumApart from propranolol, have you tried any other meds for your current symptoms?
-NoPlease can you describe your current symptoms in a bit more detail?
-Laying or sitting is sheer agony. I have this numbness, hard to describe sensation in my brain that makes me feel psychotic. I also have bugs crawling in my legs and this feeling in my spine. The feeling originates in my brain though. Pacing helps, but doesn't drive away the sensation completely.Do you feel very restless and find it very difficult to sit still?
-Yes!!!
Posted by NealMcCoy on February 18, 2005, at 13:02:57
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 13:00:47
Yes, for benzo withdrawal. I know that you never hear of benzo's and akathisia, but I am utterly convinced this is it! When starting paxil 3 years ago I had this same sensation and this is what it felt like. I had it for a month before I quit the paxil and it went away after that.
Posted by ed_uk on February 18, 2005, at 13:41:21
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 13:00:47
Hi Neal!
Sorry about all the questions. I didn't want to make any suggestions before I knew more about you because otherwise I'd give bad advice :-)
What does your psychiatrist say about the akathisia-like symptoms? Did s/he diagnose akathisia and prescribe propranolol?
Did the akathisia-like symptoms start when you stopped the Valium completely or did you suffer akathisia while reducing the dose? Did the bad withdrawal symtoms start when you reached a particular dose eg. 1mg/day.
Do you have any other withdrawal symptoms at the moment?
What dose/regimen of propranolol are you on? Is it causing any side effects?
When you were on 10mg/day Valium, how may times a day did you take the drug? eg. 10mg once daily, 5mg twice daily etc.
>Did you have any side effects while you were taking the benzo?
-Yes. Increased anxiety, headache, muscle tension, blood sugar problems.Did you suffer anxiety all the time or only when the effect of your last dose of Valium was wearing off?
Would you like to try a different medication to treat your akathisia?
How do you feel about going back on a low dose of Valium and tapering more gradually using Valium syrup and an oral syringe?
Do your current symptoms feel exactly like the symptoms you felt when you started Paxil? Are there any differences?
You don't live in the UK by any chance do you?
Here is a little definition of akathisia.....'Akathisia manifests as pacing and a total inability to sit still. If forced to sit still the person experiences extreme anxiety and agitation. In bad cases the anxiety and agitation may get worse even while the person is moving. Akathisia is dangerous in that it couples an extremely unpleasant experience with an intense urge to act, possibly leading to suicide attempts.
Akathisia is a common extrapyramidal side-effect of antipsychotic (aka neuroleptic) drugs. Akathisia usually responds well to drugs commonly used to control extrapyramidal side-effects.
Akathisia can, more rarely, be caused by anti-depressants or occur spontaneously.'
Ed.
Posted by Phillipa on February 18, 2005, at 14:03:41
In reply to Re: Akathisia, is this it? » NealMcCoy, posted by ed_uk on February 18, 2005, at 13:41:21
From someone who suffers with anxiety, it sounds like your anxiety flaring up. Has anything happened in your life to cause new anxiety? Both good or bad? Fondly, Phillipa
Posted by NealMcCoy on February 18, 2005, at 14:03:49
In reply to Re: Akathisia, is this it? » NealMcCoy, posted by ed_uk on February 18, 2005, at 13:41:21
Hey Ed,
I took a benadryl this morning and it seems to be taking the akathisia away somewhat, so I am to sit still a bit. I am debating whether or not to take my propranolol dosage in fear that my heart rate will go too low because of the benadryl...Anyhow, I will answer your questions.
What does your psychiatrist say about the akathisia-like symptoms? Did s/he diagnose akathisia and prescribe propranolol?
-All of the psychiatrists I have seen never would've been able to diagnose this had I not told them myself it was akathisia. I was also the one who suggested propranolol. In other words, the docs seem to not have a damn clue to what this symptom is all about.
Did the akathisia-like symptoms start when you stopped the Valium completely or did you suffer akathisia while reducing the dose? Did the bad withdrawal symtoms start when you reached a particular dose eg. 1mg/day.
-They started when reducing the dosage. When I got to 1 mg, the akathisia flared up big time. The bad withdrawal symptoms were there irregularly from 5 mgs down. I can handle the bad withdrawal symptoms. I cannot handle the akathisia. I have noticed that overworking my body seems to be the root cause for the akathisia.
Do you have any other withdrawal symptoms at the moment?
Just some fatigue, but that is overshadowed by the akathisia. I am so focused on this symptom that all of the other ones seem irrelevant.
What dose/regimen of propranolol are you on? Is it causing any side effects?
-No side effects that I know of. I have been taking 20 mg's of it twice a day. Once right after I wake up and once in the evening.
When you were on 10mg/day Valium, how may times a day did you take the drug? eg. 10mg once daily, 5mg twice daily etc.
-I took 10 mgs before bedtime. So I did only one dosage.
>Did you have any side effects while you were taking the benzo?
-Yes. Increased anxiety, headache, muscle tension, blood sugar problems.Did you suffer anxiety all the time or only when the effect of your last dose of Valium was wearing off?
-It was pretty much constant. It varied in intensity though. Most of the time it was low level, but it was annoying nonetheless.
Would you like to try a different medication to treat your akathisia?
-I would like to try anything. However, a friend of mine who suffered from akathisia said it took a week or two for the stuff to kick away the symptom. So I am thinking I may have to wait a while to see if this works?
How do you feel about going back on a low dose of Valium and tapering more gradually using Valium syrup and an oral syringe?
-I think that seems like a good option.
Do your current symptoms feel exactly like the symptoms you felt when you started Paxil? Are there any differences?
-It feels about 90 percent the same. Only difference is that now I have other withdrawal symptoms such as fatigue and muscle aches. During the paxil I wasn't suffering from any kind of withdrawal.
You don't live in the UK by any chance do you?
-No, but I mentioned a friend of mine above(the one who suffered akathisia.) He is from the UK. I take it you are from the UK?
Posted by NealMcCoy on February 18, 2005, at 14:05:27
In reply to Re: Akathisia, is this it?, posted by Phillipa on February 18, 2005, at 14:03:41
No No. I have had anxiety. I have had severe anxiety. This is not it. Anxiety doesn't make me suicidal. This is making me very suicidal. And I have been working on my anxiety through relaxtion, yoga, diet etc.. for 2 years and that has helped me manage. This cannot be managed by that because I cannot sit still
Posted by Phillipa on February 18, 2005, at 14:23:23
In reply to Re: anxiety, posted by NealMcCoy on February 18, 2005, at 14:05:27
I can't sit still long enough to do Yoga. I've tried. What's your secret? I walk all the time and it's boring. Fondly, Phillipa
Posted by SLS on February 18, 2005, at 14:27:31
In reply to Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 0:46:46
What leads you to believe that you are experiencing akathisia and not benzodiazepine withdrawal?
- Scott
Posted by NealMcCoy on February 18, 2005, at 14:30:44
In reply to Re: Akathisia, is this it? » NealMcCoy, posted by SLS on February 18, 2005, at 14:27:31
Akathisia can be a symptom of benzo withdrawal, so i'm told. All's I know is that it is beyond intolerable. This is coming from a guy who has experienced every other withdrawal symptom in the book. Those were fun compared to this.
Posted by ed_uk on February 18, 2005, at 14:44:42
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 14:03:49
Hello!
>I am debating whether or not to take my propranolol dosage in fear that my heart rate will go too low because of the benadryl.
I doubt that it would go too low. If your pulse is already low or you suffer from low blood pressure I would be concerned. You are on a very low dose of propranolol. (Doses of 160-320mg are used to treat hypertension. 640mg/day is sometimes considered to be the absolute maximum dose but very few people actually take that much.)
Diphenhydramine (Benadryl) inhibits cytochrome P450 isoenzyme CYP2D6, which is responsible, in part, for the metabolism of propranolol. Theoretically, diphenhydramine might be expected to increase the propranolol plasma concentration but despite widespread use of this combination there are no reports of an interaction.
What is your heart rate at the moment?
What dose of Benadryl did you take? How many doses have you taken so far? If the Benedryl is more effective than the propranolol, you could stop the propranolol and continue the Benadryl. The usual dose of Benadryl is about 25-50mg three or four times a day. Any side effects from the Benadryl?
>When I got to 1 mg, the akathisia flared up big time.
How was the akathisia when you were on 2mg/day?
>I have been taking 20 mg's of it (propranolol) twice a day. Once right after I wake up and once in the evening.
Sometimes it can help to take it more often, you could try taking 10mg four times a day.
>I took 10 mgs Valium before bedtime. So I did only one dosage.
Your anxiety was probably a mild form of withdrawal. Despite what people often say, it is frequently necessary to take diazepam in divided doses to avoid withdrawal symptoms occuring between doses eg. you could have taken 2.5mg four time a day.
>How do you feel about going back on a low dose of Valium and tapering more gradually using Valium syrup and an oral syringe?
-I think that seems like a good option.I'd suggest taking about 2mg/day in divided doses eg. 0.5mg four times a day. You can decrease the dose gradually using diazepam liquid and an oral syringe marked in 0.5ml divisions.
>I take it you are from the UK?
Yes, England. What about you?
Regards,
Ed.
Posted by ed_uk on February 18, 2005, at 14:50:17
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 14:03:49
PS. Since the term akathisia is often reserved for the restlessness due to serotonin reuptake inhibitors and dopamine antagonists I'm not sure whether I would call your symptoms akathisia or not. The fact that your current symptoms resemble your Paxil restlessness suggests that it might be appropriate to call your symptoms akathisia. Anyway, I'm not sure it matters what we call them, I'm sure you'll find it possible to withdraw from diazepam if you taper the last 2mg more slowly.
Ed.
Posted by NealMcCoy on February 18, 2005, at 14:57:55
In reply to Re: Akathisia » NealMcCoy, posted by ed_uk on February 18, 2005, at 14:44:42
Ed,
I took 50 mgs of benadryl.It was the first doaage I have taken. I went ahead and took the 20 mgs of the beta blocker and my heart rate is at 68. I may actually try and go to the hospital and get more propranolol. LoL, I feel like a junkie for god sakes!
The akathisia was non existent at 2 mgs a day. When I was at 1 mg a day I had a severely stressful event occur in my life and i think this might have sent my system into overdrive and caused me to get this symptom.
Do you think it is vital that this symptom be controlled? There is no way I could get off of valium if this symptom were to be present. I consider it life/sanity threatening in a way. Am I exaggerating by saying that?
How big should the reductions in dosage be with the liquid valium? I feel kind of hopeless now and like i'll be a prisoner on this stuff. I sure hope that any other person would react the same way.
I am from the Texas. I have a few friends in the UK. Sounds like a cool country to live in. Do you live by London?
-Neal
Posted by NealMcCoy on February 18, 2005, at 15:00:19
In reply to Re: Akathisia, is this it?, posted by ed_uk on February 18, 2005, at 14:50:17
I think it's gotta be akathisia. However, it is very very rare in benzo withdrawal as I'm told. So maybe I am a freak of nature or something.
Posted by Phillipa on February 18, 2005, at 15:05:36
In reply to Re: Akathisia, posted by NealMcCoy on February 18, 2005, at 14:57:55
Maybe if you've had this stressful event, now is not the time to be going off the medication. Maybe the other symptoms are that you need more medication. Just to get you through this. Do you have someone you can talk with? Fondly,Phillipa
Posted by ed_uk on February 18, 2005, at 15:21:38
In reply to Re: Akathisia, posted by NealMcCoy on February 18, 2005, at 14:57:55
Hi,
>heart rate is at 68
That's normal, don't worry.
> I feel like a junkie for god sakes!
LOL, no one is going to think you're a junkie for asking for propranolol.
>I consider it life/sanity threatening in a way. Am I exaggerating by saying that?
No, I don't think so, you said it was making you suicidal.
>How big should the reductions in dosage be with the liquid diazepam?
In the UK, diazepam liquid contains 2mg/5ml. I don't know whether a liquid containing the same concentration is available in the US. Using an oral syringe, you can easily reduce the dose in tiny steps. Unfortunately, I can't tell you how quickly to reduce, you will have to experiment!
>I have a few friends in the UK. Sounds like a cool country to live in. Do you live by London?
No, I'm from Yorkshire. Why do you think it sounds cool?
Ed.
Posted by SLS on February 18, 2005, at 15:22:17
In reply to Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 0:46:46
> I have this indescribable, agonizing feeling in the center of my brain that makes me wish that I were not alive. It is like nothing I have ever experienced in my entire life. I do also have the crawling out of my skin sensation. I took 20 mgs of propranonol and it doesn't seem to be working. I am getting a bit concerned. This feeling isn't anywhere near bearable. It's gotta be the worst feeling known to man..Any comments or suggestions?
For what it's worth, I think you should treat your condition as being benzodiazepine withdrawal. I do not think you have akathisia.
- Scott
Posted by ed_uk on February 18, 2005, at 15:26:55
In reply to Re: Akathisia, is this it? » NealMcCoy, posted by SLS on February 18, 2005, at 15:22:17
>For what it's worth, I think you should treat your condition as being benzodiazepine withdrawal.
I suggested a slow taper from 2mg diazepam liquid. Propranolol might be slightly helpful, whatever we call it. Although the symptoms sound rather like akathisia, the pathophysiology is probably very different, so response to 'traditional' anti-akathisia drugs is unlikely to be good. This is why I suggested the taper.
Ed.
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