RNS with depression - r u out there?

hollyster · Jul 9, 2005

Does your employeer have an EAB program? You could get short term help. It is suppose to remain confidential. Check with your HR.

Gook Luck

Holly

Princess74 · Jul 9, 2005

Well, I am not a Rn yet but I do suffer from depression and anxiety. More so anxiety than depression. I have been on Zoloft for 11 years now, along with Ativan. My panic attacks are actually becoming more frequently now than before. I have been under stress this past year and a half. Got divorced, moved back in with mom and dad, then my dad passed away at Christmas, I've changed jobs and now I'm starting school too. NO WONDER I'M IN A PANIC!

I really do not feel depressed at all, I don't feel like I need to be on the Zoloft anymore but I sometimes wonder if I will ever be able to get off the Ativan, I am a bundle of nerves somedays and I've gotton to wear I just get the worst hot flashes that you can imagine which send me into a panic attack almost every time. (I'm only 30, so I don't think its menopause quite yet)

I do not feel like the medications are working as well as they should, or even as well as they did before. I know there are other meds out there but I am scared to try them. I do not have any health ins either but I do plan on seeing my Doc as soon as I can so that we can come up with a better plan. I'm so tired all the time, I feel uptight, my neck and shoulders are in knots, I even get shaky sometimes. I've had every bloodtest imaginable done and everythings always normal so I have to think that it is all just my nerves. I sure wish I could get a hold on them. Sorry if I am rambling. I just wanted to let you know that you are not alone. Feel free to PM me if you ever need to talk.:)

Guitar_Heroine · Jul 9, 2005

I can't answer your questions except to tell you my experiences. I, too, have rapid reactions to ssri's. I'm dxd bipolar, but if I miss two days in a row I start to slip into depression and can tell within days when I've had to increase the dosage. And yes, you can get accustomed to your dosage and need an increase. Good luck and I hope you feel better!

wanderingdog · Jul 9, 2005

OK
I'm supposed to know the answers. But I dont, so here goes.
I was diagnosed 15 years ago with depression. I have been on various anti-depressants with some success (and in therapy) tried to come off them, etc...
Long story short, Prozac seems to be the best fit for me. All I know is that I have a shot at relatively normal life on 30 mg a day. Have been on it now about 5 years.
I swear that if I go off these meds, I feel the tension and anxiety, irritability and being overwhelmed within a week. The books say this doesnt happen. If my dose is changed, I feel it within a week.
I've had a rough summer. Youngest going away to college, adjusting to new life, etc etc... I'm fighting hard to stay out of bed and go to work every day. My irritability is very high at times. My kids say I'm really ugly at times. Stupid things can really set me off (the laundry is suddenly just driving me wild, it HAS to be done, NOW.) I have no insurance (I'm per diem).
#1 Has anyone else heard of this rapid reaction to this ssri?
#2 Am I just hiding out from the possibility that I should be on anti-anxiety meds?
#3 Is it possible Ive just become too "used" to this drug and need an increase?
A visit to my doc would be my first choice if I had $60 for an office visit. But my meds cost me $80 a month. And, sigh, when you need your meds to work is a really bad time to change them around, since you dont have the tolerance to wait for it to take place. It really isnt an option right now.
Am I rambling foolishly? I guess I want to know if I sound familiar. Does anyone else go through this?
A nurse where I work lost her job last week due to a series of emotional breakdowns she has experienced that have compromised her work. My heart goes out to her. So many people seem to think that nurses should not get sick. ESPECIALLY emotionally. I dont see myself messing up at work, but I do tend to feel overwhelmed a lot at home.

Of course the following is not medical advice nor should it be acted upon without a practitioners consultation.

I'm sorry that your symptoms are making you feel out-of-control and irritable. These are classic signs of depression, not necessarily anxiety. It would be great if you could see a psychiatrist--most have sliding scale. Many larger communities also have "free clinics" for psychiatric issues. They can also provide free samples or submit you for subsidies from the drug companies.

Prozac, as you probably know, is one of those "shotgun" SSRIs. It doesn't target specific receptors like some of the newer ones. It is not unusual for anyone to have "rapid" cycling with any medication. What the books say (and it is primarily addressed with clients because they will stop taking the Prozac if they don't feel their depressive symptoms leaving expeditiously) is that it normally takes 4 to 6 weeks for the full effect of the medication. We know that it has some effect within days or weeks. For this reason prescribers normally want to keep a very close eye on people just starting Prozac or other SSRIs. It is in that "ramp up" phase that people either become violent and kill themselves or others.

But I'm not sure from your description if you are still taking your Prozac. For this discussion, I'm assuming you are still taking your Prozac.

The pharmacodynamics of a medication is very individualistic. All the information from studies and anecdotal are gross approximations of what a drug normally does. Many people are "quick" processors and others are "refractory" to Prozac depending on their genetics and source of their depression. Many of the neurochemicals can cause depressive symptoms. There is also the placebo effect, where one-third of all clients improve on sugar pills, albeit short lived.

As nurses we try to take advantage of the placebo effect by presenting the treatment in a positive fashion. So, what your expereincing could be a placebo effect early in the course of the medication and then when the med is at therapeutic levels you benefit from the medication as your placibo effect wears off.

Be that as it may, except for the 80 dollars a month, why would you want to discontinue a medication that is helping you? It is not uncommon for psychiatric symptoms to increase during times of stress--similar to a diabetic who needs a change in insulin depending on stress. You have considerable room on your 30mg of Prozac to increase to the recommended max of 80mg per day (By the way, Prozac is a very good medication for anxiety disorders, if you feel you have these symptoms). This may work well, then after much of the stress, especially your youngest's transition, has passed, taper to your Prozac to the 30mg dosing.

With some of the experiences you're having--not wanting to get up--you may want to consider Wellbutrin (extended release) as a supplement to the Prozac you're already taking. Wellbutrin is very good at "activating" our systems. It can give you a kickstart in the morning without the risks of stimulants and would help supplement your 30mg with your situational depression from your current stressors.

Of course, the first think we look at when our symptoms increase is: SLEEP. Are you getting enough sleep? If not, with the addition of Wellbutrin, I would suggest you take something like Seroquel at 25 to 100 mgs before bed. That would help with your irritability and will allow you to go to sleep if you're anxious. Anxiety is the leading cause of "not falling asleep," while "early rising" is common with depression. Seroquel at sub-therapeutic doses for psychosis, would relieve both of these sleep problems.

You have alot to sort out, but like people with diabetes, people with chronic depression shouldn't go off their medication. Chronic treatment is advised when the depression remission is less than the periods of exacerbation. It is also advised if you've had several bouts of major debilitating depression with severe suicidal ideation or acts. Medication is part of chronic treatment of psychiatric disabilties.

Good luck!

peace. timothy

JennInColumbus · Jul 9, 2005

#1 Has anyone else heard of this rapid reaction to this ssri?

#2 Am I just hiding out from the possibility that I should be on anti-anxiety meds?

#3 Is it possible Ive just become too "used" to this drug and need an increase?

1. I have clinical depression and I feel a missed dose (Zoloft in my case) or a change in dosage in 24-48 hours. It isn't supposed to happen that fast, but it does. I just happen to be very drug sensitive.

2. That is really up to you, the fact that you are asking may be the best indicator that you do.

3. I have had to up my dosage twice in the two years I've been in Nursing School. That may be due to stress or just becoming acclimated, who knows, I am just happy that it continues to work!

As far as RNs who have depresssion being out there, I know that something like 20% of my nursing class, that I know of, is on antidepressants.

Editorial Team / Admin · Jul 9, 2005

OK
I'm supposed to know the answers. But I dont, so here goes.
I was diagnosed 15 years ago with depression. I have been on various anti-depressants with some success (and in therapy) tried to come off them, etc...
Long story short, Prozac seems to be the best fit for me. All I know is that I have a shot at relatively normal life on 30 mg a day. Have been on it now about 5 years.
I swear that if I go off these meds, I feel the tension and anxiety, irritability and being overwhelmed within a week. The books say this doesnt happen. If my dose is changed, I feel it within a week.
I've had a rough summer. Youngest going away to college, adjusting to new life, etc etc... I'm fighting hard to stay out of bed and go to work every day. My irritability is very high at times. My kids say I'm really ugly at times. Stupid things can really set me off (the laundry is suddenly just driving me wild, it HAS to be done, NOW.) I have no insurance (I'm per diem).
#1 Has anyone else heard of this rapid reaction to this ssri?
#2 Am I just hiding out from the possibility that I should be on anti-anxiety meds?
#3 Is it possible Ive just become too "used" to this drug and need an increase?
A visit to my doc would be my first choice if I had $60 for an office visit. But my meds cost me $80 a month. And, sigh, when you need your meds to work is a really bad time to change them around, since you dont have the tolerance to wait for it to take place. It really isnt an option right now.
Am I rambling foolishly? I guess I want to know if I sound familiar. Does anyone else go through this?
A nurse where I work lost her job last week due to a series of emotional breakdowns she has experienced that have compromised her work. My heart goes out to her. So many people seem to think that nurses should not get sick. ESPECIALLY emotionally. I dont see myself messing up at work, but I do tend to feel overwhelmed a lot at home.

First of all, I am concerned, because you stated this, if you are indeed taking the prescribed amount everyday. No doses missed. If not, you will have a series of untoward events. If you are, you MUST see your PCP as soon as possible and discuss with him/her about your "swings".

Have you asked for samples? Many providers will give them to you, thus reducing your financial situation. Please do not let the fee for office visit deter you. You do need followup closely due to the fact that you seem uncontrolled at this time.

Have you had a thorough checkup lately including (but not all inclusive) ruling out things such as chronic fatigue syndrome, Fibromyalgia, thyroid disorders, B12 deficiency, and of course, bipolar disorder. You MUST seek out a practitioner who can help you dirrerentiate amongst a group of disorders that mimick depression alone.

The inability to get out of bed may be true depression and could be a sign of an underlying disorder, physical and/or mental.

So, please seek out the advice of your PCP and good luck. I sympathize with you and know it has to be hard getting up everyday feeling as you do.

Do not give up!! We are here to listen and help.

Above opinion is for your use and NOT to be taken as the practice of medicine in any degree.

zacsmimi · Jul 9, 2005

Yes, to be honest, I miss doses from time to time. More likely to miss them when I am experiencing symptoms (go figure) but I'm trying hard. I have 10 mg tabs so I could just increase myself to 40mg for a while and see if it helps until I can get in to see my GP. I can't tell you how much it helps just to be able to talk about it like this... no pressure, no judgement, other professionals. I'm a really good nurse, and it seems odd to me when I can't "cure" myself. I've been on Wellbutrin before, I'm not sure why we changed it, I think I got dizzy on it. I know my mouth dried out to the point where my speech was affected. That would be a good reason, huh?

I have pretty bad PMS, more than my share of headaches and muscle tension. So far, this round, 25mg of benadryl can get me to sleep- and keep me there most of the night. I slept alot at the onset of this "bout" - which is usually my cardinal sign of sinking. I could easily sleep 15 hours+ a day. When I recognize whats happening I make myself get up but I don't always stay up. If I'm awake, I can go DO something when the "swing" comes around and I feel motivated for awhile. If I'm sleeping I miss it altogether.

I have made an appt to see my counselor again. That will probably help. Can't hurt. Helps a lot to know I'm not alone, I'm not losing it, and that there is a light at the end of the tunnel. Can someone (timothy?) explain more to me about the differences between how anxiety and depression present? Again, thanks so much for being out there and caring enough to answer.

live4today, RN · Jul 9, 2005

...............................................................the inability to get out of bed may be true depression and could be a sign of an underlying disorder, physical and/or mental...............................................................

i agree based on my own experience with depression, etc. i was pretty much having the blahs, not wanting to eat, just tired all the time, sleeping or lazing around, didn't want to hear the phone ring so would turn off the ringer, and so forth. i had been on celexa four years, took a years break from it, and started having the same symptoms again. for several months now, i've been back on celexa. the doc wanted me to take 40 mg a day, but hard-head me only took 20 mg a day because the last time i started the 40 mg, i had the shakes a lot, so went back to 20 mg on my own. i know...shame on me. when the medicine treatment nurse followed up with me and learned i was only taking half of the prescribed dose, and learned my symptoms were still not cleared up, she told me she would report to my doc that i cut the dose, and advised me to make an appt. sooooo...have't made the appointment yet -- aren't we nurses as stubborn as docs sometimes:uhoh3: anyhoo...i went back to the prescribed amount to see if i would have a repeat of the shakiness, etc. i felt before. not so far, and i've been on the increased dose a month now. so, now i can make my doc appt. and be able to tell him how the 40 mg is working for me. :)

my lab workup came back during all this time stating my thyroxine level was low, so now i take cytomel for that. the doc says this was another reason for my symptoms, thus.....have your doc do a thyroid panel and specifically target your thyroxine level.

we can have depression, and need the medication, but as aging women we need to check into other reasons for our symptoms when we are over the age of forty when hormone levels begin to change according to our body's signals, etc.

whoever said living is grand hasn't been born yet. :rotfl:

((((((((((zacsmimi)))))))))) we're here for you whenever you need us. feel free to send me pms if you want more information on what i've shared. one thing about being older (53 for me), we are no longer shy about sharing something we've gone through if it helps others. embarrassment hardly lives in us anymore. :rotfl:

ARNPsomeday · Jul 10, 2005

It is common that patients need a change in medication because the one that did the trick for years no longer works.

Venlafaxine (Effexor XR) targets the levels of both serotonin and norepinephrine= fights both depression and anxiety. Maybe ask your psychiatrist?

Whatever you decide, do follow up and take care of yourself. As others have said there are free meds, samples, and a psych consult can be paid off bit by bit as you can afford to make small payments.

Best of luck.

Thunderwolf, MSN, RN · Jul 10, 2005

Timmy gave some excellent feedback. Good job. Also, Cheerfuldoer brings up a good point...medical conditions which may mimic or exacerbate the symptoms of depression and/or anxiety. Very good point. Even depression/anxiety doesn't happen in a vaccuum.

I also agree with Tim in that stress is a major important factor. And with regard to this, when times are more stressful or depressing, it may be the time more than ever to put into place improved coping techniques, self nurturing practices, structuring your activities and improving the use of one's supports (non-pharmacological interventions). Meds do have their place...but, also let's look at the big picture as well. Great thread. Hope all our input helped.

Morning-glory · Jul 16, 2005

I too, am on medication and respond quickly to Manerix. I was Dx'd 10 years ago with ADD with anxiety/depressive traits. I was also very distractable. Nursing school brought this to a head. I crashed and burned a couple times in school and had been asked by some very caring instructors to get help. I refused!

After finishing my fifth year of a 3 year progam, I still had one year left to achieve my goal. I was determined to get my diploma. So I went to the centre for students with disabilities. 20 hours of testing later, Tada- ADD and a learning disability!

I started on desipramine. Went from the bottom 5% of my class to the top 10% in 3 months. By Christmas, I was on a roll.

I was up to 37.5 mg/day. After school was done and divorce was complete, I was able to come down to 1/2 tab a day. Still had some social anxiety. I was switched to Manerix. Took about 2 days on the med for me to start feeling the difference.

2 months ago, I was started on Strattera. Made me way too sleepy to function. Decreased the dose to 20 mg/ day and still had to pull over while driving to sleep off the effects that appeared very suddenly, in no real pattern. Couple of days ago, I called my shrink and said "enough". I want my Manerix back. The Strattera is an ADD specific med, but it wasn't doing it for me. I was smoking more, sleeping all the time and the S/E were too uncomfortable to put up with while not getting the benefits from the med.

I just started a new job. I am now learning to be a psych nurse. I took this job after a lot of thought. Didn't want to go in there looking for self-help. I may play with my manerix doses to find the ideal dose. It isn't the ideal medication as my symptoms sometimes creep up on me, but I learn better, sleep better, and feel smarter.:rotfl:

Helps my brain work better.

So meds need to be taylored to you. And they may poop out on you after a while. I was open to change my meds because the ones I was on wasn't ideal.

Same as we have such a vast catalogue of pain medications. If morphine and asprin worked well for everyone, there wouldn't be a need for anything else. But everyone responds differently. I, like most people will stop meds to see if we really need them. I don't like having a dry mouth and sharing my oral cavity with a fungus, but if I don't take my med I am much the worse for wear.

I have tried other medications. Wellbutrin gave me 3 weeks of tonsilitis and pharengitis that got out of hand and lead to pneumonia. I looked it up and there it was- may cause throat infections- right there in the med profile. Ritalin gave me auditory hallucinations. Won't be doing that again. Ativan was good for getting me to sleep, but I couldn't get up the next morning, the stuff lasted for about 18 hours in my system.

But at the end of the day, I have a loving relationship, a great new job that I don't have to work nights anymore, no more 12 hour shifts, a few select great friends and 3 adorable cats. I am looking at getting married again, buying a house and working to live, not living to work.

I know where me ends and the world begins. I have learned to interact without putting my own mental health in jeapordy.

Best of luck finding what will work for you. Listen to what your body is telling you and do something about it.