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  1. Nov 30, '03 by RN-PA
    GOSH! Thanks to all for the great responses and input! I have a lot of research and mulling to do.
    Originally posted by sphinx
    My question is, have you spoken to your physician about this? My personal advice, which you could take it or leave it, would be to have your primary MD refer you to a psychiatrist or a psychiatric nurse practitioner. Not because you're crazy or need a shrink....but because they are specialists when it comes to these meds, and can help you in this decision, and are more likely to put you on the right dosage,etc. Not that a primary MD isn't capable of prescribing meds for anxiety, I have just found with myself and others, that having a "specialist" has cut down a lot of that "trial and error" process, and made things go a lot smoother. Maybe you have already done this. If so, ignore me!

    Good luck in whatever you end up doing.
    I especially appreciated this line, Sphinx: "Not because you're crazy or need a shrink." Because I probably think I am a little crazy and could probably use a shrink. I've had counseling for periods of time to get through life's rough patches the past 25 years, and learned many ways and tools to help cope.... Now if I would JUST put them into practice.

    I was planning on going to my primary MD after I had researched various meds, and then I could ask for what I wanted. I did that with Paxil a while back, but mainly requested it because it was helping a fellow nurse friend who was also struggling with similar issues that I was. I would prefer someone with more of a psych background to prescribe meds rather than my PMD. (I've heard from a number of people who have gone to one of the partners in the practice and this doc pushes Prozac on just about everybody-- I figured he must have stock in the company! He tried to convince me to take Prozac years ago when I was asking for renewal of some tension headache meds-- Ibuprofen and Flexeril. Sheesh-- I'd only known this guy for less than 10 minutes! The doc I usually see prescribed the Paxil for me after talking it over with her on the phone!)

    From reading responses here, researching on the 'Net, and my own experience with Paxil, I pretty much know what I don't want-- I know I don't want Xanax, and a number of you have recommended Lexapro which I'm going to research.

    Originally posted by Will Benson
    RN-PA

    Wow! You have a lot of advice! I hope my contribution doesn't "muddy the water" for you. Have you talked to your doctor about how to handle the stress non-pharmacologically? Talk with the occupational therapists on the psych unit of the hospital where you work. They probably have stress reduction skills you can practice to lower your stress level. Benzodiazepines (like Ativan, Xanax, Klonopin, Librium, Valium, and others) are extremely addictive and can produce a withdrawal that can be fatal if not handled properly. Are you sure you want to open that door? BuSpar CAN be effective, but it takes a long time to start working. Also be aware, if your employer does periodic uring drug screens, benzos will show up in your urine. They can also impair judgment. I don't want to scare you away from help, but there are pretty serious consequences in many states, if you are ever accused of being chemically "impaired" on duty. What ever you can do to handle your anxiety outside of medication (or alcohol) will be your best bet.
    All good thoughts and advice in addition to everyone else's-- Thank you! We don't get periodic drug screens at our hospital, and I agree with everything you've said-- I would prefer to continue taking care of the anxiety naturally, if possible. I feel better today because I had two long talks with my husband about my feelings, meds, etc. I've also had 3-4 fairly cleansing cries in the last 24 hours, and am trying to stay more positive in my "self-talk". I went in to the hospital today on my day off and practiced on our new computer system for almost 3 hours, and learning more about it has somewhat lessened the anxiety. I'm also signed up for a Spinning class at the gym tomorrow morning, so whatever stress the tears didn't release, some heavy-duty sweating WILL! I would also like to spend more energy praying and less in fretting.

    Thank you again who all who've responded, and I'd be happy to get even more responses if anyone else cares to share their experience with meds and/or alternatives.
  2. Nov 30, '03 by pappyRN
    Hi RN-PA,

    I am unable to take any of the AD's in the SSRI category due to the fact that I experience a phenomenon known as serotonin syndrome.

    My sister is currently struggling with weaning off Effexor- a really hideous medication when you are late with your dose or when you try to wean off without some type of medical support for the severe, repugnant symptoms one experiences with weaning fgrom this drug. I can't believe my eyes as I watch the poor thing go through absolute hell in an attempt to get off this poison. It infuriates me and her that NO one, not the doctor nor the pharmacist warned her about the potentially gruesome physical dependence that develops with it's use. In addition to feeling like her blod is boiling, she feels as if she is suffocating and losing her mind. She is being treated for clinical depression. Her previous shrink had her on 300+ mgs of Effexor, Prozac, Nortriptylin, and Wellbutrin in addition to the Duragesic patch that is prescribed by her pain management doctor for severe fibromylagia. When she first started the Effexor she had violent headaches and her shrink told her to just sit tight and they will go away on their own. They did but what happened insterad is that she became more easy to anger and lash out, she had very frequent panic and anxiety attacks, and felt like she wasn't really in her world for lack of a better way to describe it. I found some accounts from pts on Effexor and how horrible their side effects and withdrawal was for them. I spoke to her about these unpleasant behaviors that she displayed and then went with her to he new shrink, of course with her permission to be in there with her. I gave him some copies of the stories I had found. He was at first skeptical defending the Effexor by saying it is a very useful drug for some and has it's place in psychiatry. My sister insisted that he give her a wean schedule at her next visit but didn't remember to ask for something to assist her with the symptoms she was bound to feel as she withdrew from Effexor. We ended calling him on the phone for an RX for Valium because she was beside herself with the horror. She is so very angry and offended that NO one told her about these deep dark little secrets about Effexor. He is withdrwaing her from it at 37.5mg at a time every three weeks and she is still feeling these exasperating symptoms of withdrawal.

    You might ask your doctor for Remeron or Nortriptylin(Pamelor), Desipramine(Desyrel), Trazadone, or Amitriptylline(Elavil). My personal preference is Norti[ptylin. I am not hung over and I haven't felt this well as far as the clinical and situational depression goes, in a long time. Elavil made my mouth and mucous membranes way to dry and I would cough half the night and guzzle water to quench that very dry throat. One thing about the tricyclic antidepressants is that they make some patients crave sweets or have a way bigger appetite. It is something to be aware of so you can keep track of.

    Good luck and I hope things settle down for you soon. You are so smart to recognize there is a problem, admit it and seek help BEFORE it becomes a huge problem.

    Warm personal regards,
    PappyRN
  3. Nov 30, '03 by RN-PA
    Thank you for sharing your story and recommendations, Pappy, as well as your sister's nightmare-- So sorry to hear about her horrible withdrawal! I had contributed and followed a website bulletin board on Paxil while I was taking it, so knew I had to wean EXTREMELY slowly. I had been taking Paxil 20 mg and slowly cut back and alternated doses daily for close to 3 months. Near the end of the weaning, I was cutting 5 mg into 2.5 mg-- taking these little slivers of the pill-- and thankfully, experienced very little withdrawal symptoms. I was always scared that if I ever needed emergency surgery and had to be NPO for more than one day, I'd be having BIG problems with the Paxil withdrawal.

    I hope your sister is feeling better and back to normal, soon!
  4. Dec 2, '03 by mattsmom81
    I am glad to know about this...I see now in retrospect why one of my ICU patients may have become so miserable ...she had missed Effexor doses due to vomiting/GI bleeding, and since she was hypotensive with a HGB of 6 and receiving emergency transfusions we did not catch this fact for awhile....

    I've also found in my ICU that our elderly patients who miss their Risperdal and similar drugs can have some wild mood swings and symptoms....something good for us all to remember in our patient care.
    jewelspassion likes this.
  5. Dec 3, '03 by teece3
    I agree with much of the what has been written previously. I would avoid benzos at all costs not only because they are addictive but because they can "impair" you. And no one needs to worry about being impaired when they're trying to deal with anxiety and stress from their job. Frequently our doctors use low dose Seroquel or Neurontin for anxiety. Additionally, there is also Xanax XR which has been released and requires only once a day dosing. Allegedly it doesn't give the "buzz" like the benzos(regular Xanax) and it lasts 24 hours. Both Celexa and Lexapro are very effective in reducing anxiety. I've never seen BuSpar do anything for anyone! Find a good psychiatrist ( I believe they are the experts) and let them help you decide what's best for you. Good luck!
  6. Dec 3, '03 by IamRN
    Originally posted by renerian
    My doc put me on that for about a year after my mom died suddenly and I kept thrusting my tongue out. I could not stop. Went off it pretty quick!

    renerian
    Yuck! Sounds like extrapyramidal syndrome...I get this w/Reglan and Compazine.
  7. Guide
    Dec 3, '03 by kids
    Just an observation that is off topic (but on topic at the same time):

    The replies have been a great example of different philosophies nurses have when it comes to pharacuetical intervention:

    Prevention: a daily non-benzo medication,
    Treatment: benzos on a PRN basis when other stress/anxiety reduction techniques fail.
  8. Dec 7, '03 by montroyal
    RN PA I wish you the best of luck with what ever you do. Have you considered looking for another job? Sounds like your work enviorment is causing you all the stress. Medication can help with the the effects but not the cause. Before taking any benzo's or any other narcotics, call your BON and ask what the legal remifications of taking those meds could be. Several states require a medical review of your case before you can take these meds and work. What ever you decide, I hope things get better for you soon.
  9. Dec 7, '03 by PilotJim68
    Hummmm...all this chemical stuff...if you can afford it, you might want to try a few Relaxational Swedish Massages...will relax you, promote circualtion and take you into another world for awhile. Save yourself time and anxiety and tear yourself away from all of this research on all the "poisons" out there and try something natural first....hey if it doesn't help, you can always go to the chemicals.
    Meditation may help too...if you have time and can afford it, after your spinning class, get the massage and meditate for awhile afterwards...you'd be surprised at how much this helps and how many people use this method of dealing with stress without the risks of drugs.

    Also, you might want to consider that it takes a few weeks for some of these drugs to reach therapeutic levels, by that time, X-Mas will be over with and some of this stress may go away....just a thought
    Last edit by PilotJim68 on Dec 7, '03
    jewelspassion likes this.
  10. Dec 7, '03 by RN-PA
    Originally posted by montroyal
    RN PA I wish you the best of luck with what ever you do. Have you considered looking for another job? Sounds like your work enviorment is causing you all the stress. Medication can help with the the effects but not the cause. Before taking any benzo's or any other narcotics, call your BON and ask what the legal remifications of taking those meds could be. Several states require a medical review of your case before you can take these meds and work. What ever you decide, I hope things get better for you soon.
    Thanks for your good wishes and thoughts, montroyal; I've done a lot of thinking about other jobs and even getting out of nursing. But, without going into all the reasons, I want to stay where I am. Our hospital goes "live" tomorrow with the new computer system, and I will just have to accept and get through this period-- I have a lot of company since all of my co-workers are in the same boat.

    Originally posted by PilotJim68
    Hummmm...all this chemical stuff...if you can afford it, you might want to try a few Relaxational Swedish Massages...will relax you, promote circualtion and take you into another world for awhile. Save yourself time and anxiety and tear yourself away from all of this research on all the "poisons" out there and try something natural first....hey if it doesn't help, you can always go to the chemicals.
    Meditation may help too...if you have time and can afford it, after your spinning class, get the massage and meditate for awhile afterwards...you'd be surprised at how much this helps and how many people use this method of dealing with stress without the risks of drugs.

    Also, you might want to consider that it takes a few weeks for some of these drugs to reach therapeutic levels, by that time, X-Mas will be over with and some of this stress may go away....just a thought
    Thanks for your thoughts, too, Jim. After considering your ideas and all the other responses, I'm going to try to get through this naturally. I'm simplifying Christmas preparation as much as I can, taking more time to pray, keeping up with exercise, and I will try to schedule a massage at the gym in the next week or so. Massages are expensive, but cheaper than psychotherapy and medication in the long run. It's not that I'm against medications-- I will consider all the recommendations made here if I feel I can't get through this naturally. Only time will tell.......