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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
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.
Posted by SLS on February 18, 2005, at 15:57:50
In reply to Re: Akathisia, is this it? » SLS, posted by ed_uk on February 18, 2005, at 15:26:55
> >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.
I agree with you. Propranolol is used to treat both BZD withdrawal and akathisia, so one's positive response to it really doesn't help to create a differential diagnosis. I think the term "akathisia" is becoming overused. The observable movements seen with it are very stereotypal, and include things like rocking and continuously shifting of weight from foot to foot while standing.
- Scott
Posted by NealMcCoy on February 18, 2005, at 16:07:47
In reply to Re: Akathisia, is this it? » ed_uk, posted by SLS on February 18, 2005, at 15:57:50
Well I don't know what else to call this. I have experienced agitation before and it was nowhere near as severe as this. The agitation was annoying, but it didn't make me suicidal. If the term akathisia is confined just to SSRI's and AP's then they need a term for what I am going through. Maybe call it 'benzothisia' or something.
Posted by yxibow on February 19, 2005, at 0:50:36
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 16:07:47
> Well I don't know what else to call this. I have experienced agitation before and it was nowhere near as severe as this. The agitation was annoying, but it didn't make me suicidal. If the term akathisia is confined just to SSRI's and AP's then they need a term for what I am going through. Maybe call it 'benzothisia' or something.
It's acute benzodiazepine withdrawal, now that I can see the whole picture. If you've suffered from acute anxiety in the past and are dealing with it in an alternative way by relaxation and yoga therapy (which in itself if you're good at it can change transmitter levels like GABA and serotonin and others), and at the same time tapering from a benzodiazepine like Valium, your body may not be capable of handling both. Hence, your feeling of something that seems like akathisia but is really withdrawal. Your system may be different from others; normally its a matter of weeks or maybe a month or so to taper no matter what the anti-benzo .org crowd says, but its possible it could be longer in your body. So fussing with the taper amount may not be a bad idea and would give you relief. Propranolol would probably be an adjunctive element too.
Hope you feel better
Posted by Racer on February 19, 2005, at 10:16:20
In reply to Re: Akathisia, is this it? » ed_uk, posted by SLS on February 18, 2005, at 15:57:50
>
> I think the term "akathisia" is becoming overused. The observable movements seen with it are very stereotypal, and include things like rocking and continuously shifting of weight from foot to foot while standing.
>
>
> - ScottI twitch my leg muscles and find myself curling and uncurling my toes all the time -- does that sound like akathisia to you? I've been calling it that, but whatever it is -- it's horrible.
The worst part for me, and this is only to see if I can amuse anyone, is that I will be walking along and find that my toe curling is still going on! How, someone tell me, can I walk and curl my toes at that same time? LoL!
Posted by SLS on February 19, 2005, at 12:17:05
In reply to Re: Akathisia, is this it?, posted by Racer on February 19, 2005, at 10:16:20
Hi Racer.
> > I think the term "akathisia" is becoming overused. The observable movements seen with it are very stereotypal, and include things like rocking and continuously shifting of weight from foot to foot while standing.
> I twitch my leg muscles and find myself curling and uncurling my toes all the time -- does that sound like akathisia to you? I've been calling it that, but whatever it is -- it's horrible.Akathisia is very poorly defined in the medical literature despite being referred to often. I am having trouble locating a copy of the Barnes Akathisia Scale (BAS) on the Internet.
Muscle twitching is sometimes described in cases of akathisia. If you did have akathisia, though, it would take an extraordinary effort to be still long enough to type anything. Sitting in one place without moving is almost impossible. Although the movements are voluntary, the sufferer can't help but to be in constant motion. Movements are repeated in a stereotypic pattern. These include hand movements, rocking at the torso, crossing and uncrossing of legs, shifting weight from foot to foot while standing, and constant pacing. Subjectively, they express intolerable restlessness, agitation, anxiety, or what has been described as a feeling of crawling out of one's skin. It is extremely uncomfortable and unremitting.
> The worst part for me, and this is only to see if I can amuse anyone, is that I will be walking along and find that my toe curling is still going on! How, someone tell me, can I walk and curl my toes at that same time? LoL!I am amused.
:-)
- Scott
Posted by SLS on February 19, 2005, at 12:42:50
In reply to Re: Akathisia, is this it? » Racer, posted by SLS on February 19, 2005, at 12:17:05
This was just posted yesterday:
http://www.medafile.com/zyweb/Barnes.htm
Also:http://www.logarithmic.net/pfh/akathisia
I am a bit disappointed by the rating scale. It seems clumsy and impricise to me.
- Scott
Posted by Racer on February 19, 2005, at 14:10:13
In reply to Re: Akathisia, is this it? » Racer, posted by SLS on February 19, 2005, at 12:17:05
> Hi Racer.
>
>
> Muscle twitching is sometimes described in cases of akathisia. If you did have akathisia, though, it would take an extraordinary effort to be still long enough to type anything. Sitting in one place without moving is almost impossible. Although the movements are voluntary, the sufferer can't help but to be in constant motion. Movements are repeated in a stereotypic pattern. These include hand movements, rocking at the torso, crossing and uncrossing of legs, shifting weight from foot to foot while standing, and constant pacing. Subjectively, they express intolerable restlessness, agitation, anxiety, or what has been described as a feeling of crawling out of one's skin. It is extremely uncomfortable and unremitting.
>>
> :-)
>
>
> - ScottHmm... I do wish that they'd get it together to define these things a bit better...
Oh, well -- my "fidgets" are pretty much all the time, and it's hard to stand still to do things like wash dishes. While I sit here typing, my legs are going. I can stop them, but then I feel like a teapot about to blow as the steam builds up.
Let's make our own definition, then, if the medical community won't. I have The Fidgets. It's similar to akathisia, and probably related to it...
How's that work for you?
Posted by KaraS on February 19, 2005, at 14:24:21
In reply to Re: Akathisia, is this it?, posted by SLS on February 19, 2005, at 12:42:50
I think I had akathisia recently. I was in a highly anxious, agitated state to begin with and I took a very small amount of Effexor. I didn't feel like I was crawling out of my skin but I had all of the other symptoms just described on this thread. It was so wierd to me because I have tolerated Effexor so well in the (recent) past and have taken dosages of up to 225 mg. It has to be that the GAD and panic disorder made the difference for me. So perhaps people may be able to tolerate different medicines at different times. If I had only tried the Effexor while in an agitated state then I would have thought that I could never tolerate it.
K
Posted by SLS on February 19, 2005, at 14:33:13
In reply to Re: Akathisia, is this it? » SLS, posted by KaraS on February 19, 2005, at 14:24:21
I pretty much described a more severe presentation of akathisia. Milder forms are more problematic to identify and can look very much like the anxious or agitated states of depression and anxiety disorders which often include psychomotor activation as a symptom.
- Scott
Posted by KaraS on February 19, 2005, at 20:30:22
In reply to Re: Akathisia, is this it?, posted by SLS on February 19, 2005, at 14:33:13
> I pretty much described a more severe presentation of akathisia. Milder forms are more problematic to identify and can look very much like the anxious or agitated states of depression and anxiety disorders which often include psychomotor activation as a symptom.
>
>
> - Scott
So I might have had a milder version of akathisia OR I might just have been in a very anxious state of depression? I was already extremely anxious, but the addition of the Effexor made me want to climb the walls. I can only imagine what it's like if it gets worse than that.I hope someday I can tolerate the Effexor again. It's been the only thing so far that has given me a significant amount of relief.
Kara
Posted by Mr.Scott on February 20, 2005, at 19:09:54
In reply to Akathisia, is this it?, posted by NealMcCoy on February 18, 2005, at 0:46:46
Hi
try 50mg of Benadryl. If it's akathisia you'll get some relief. If you get relief use up to 100mg. Then talk to your doctor and get off whatever is causing it.
Scott
Posted by NealMcCoy on February 21, 2005, at 0:40:29
In reply to Re: Akathisia, is this it? » NealMcCoy, posted by Mr.Scott on February 20, 2005, at 19:09:54
Well, I am on day 4 of taking propranolol and the akathisia or whatever you want to call it seems to have lessened considerably. Whatever that sensation was, I feel tramautized. Just a question to anyone. Can you think yourself back into a feeling like that? At night when I lay down, I fear that i'll bring it back with my thoughts.Anyone had this?
Posted by ed_uk on February 24, 2005, at 12:00:49
In reply to Re: Akathisia, is this it?, posted by NealMcCoy on February 21, 2005, at 0:40:29
Hi Neal,
How are you? I tried to send you a babblemail but your babblemail was switched off.
Ed.
This is the end of the thread.
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