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Don’t mean to hijack, but while on this subject, I have a question (at the bottom)
My wife has severe anxiety and not the kind that has obvious environmental stressors. Her cortisol is elevated and has been for about 3 months due to a stressor in the family, that is gone though. She sleeps about 4 hours per night, has no appetite, and has boughts of severe depression. She started benzos early in the process, but has been taking low doses and wants to stop. We are not sure if she has true physiologic benzo withdrawal or a psychological dependence. She’s never had an addictive personality, nor has she ever had anxiety or depression.
I think the depression and continued anxiety is partially caused by the benzos. She’s tried both Lexapro (3 days before severe akathisa) and Celexa (6 days before severe akathisia), but no other SSRIs. Both of which caused akathisia, and no sleep. I think the most likely cause of the depression (full-blown suicidal ideation) is either the benzos or the continuous elevated levels of cortisol (which have been analyzed a couple times). This whole thing stemmed from insomnia associated with a very consistent pattern where she felt pretty normal and stable at night when going to bed, then out of the blue at about 2 or 3 am she’d wake for no reason and be highly agitated and then unable to sleep.
Thyroid, blood sugar, female hormones, and HPA-axis endocrinology all came out within normal ranges.
This seems to be a psychological reaction to having elevated cortisol for a sustained period, potentially aided by depressed neurotransmitters from benzos.
Is there an SSRI or other type of antidepressant that doesn’t have a period of agitation at the beginning? Tricyclics might be worthwhile, but excessive sedation comes with trazadone, don’t know about the others. Also, are there any studies that one knows of that looks at restless legs syndrome and effect of SSRI’s? She has had RLS in the past and it may be worth looking at increasing dopamine to decrease the agitation/akathisia.
Sorry for the long post, I miss my wife. Thanks
