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Persistent agitation and restlessness; inability to enjoy anything

suessmayr

suessmayr

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Joined
Jun 30, 2008
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Sydney, Australia
I take Lexapro (escitalopram) at 25mg and Wellbutrin (bupropion) at 300mg. I have Serepax (oxazepam) for PRN use.

Increasingly, over the past several months, I've been experiencing this awful thing where I can't bear to sit still or focus on any one thing for more than a few minutes. It's not exactly physical. I think it's due to the fact that I'm having terrible anhedonia - nothing gives me any reward or pleasure, so I sort of spend my days flitting from one activity to the next, not getting anything from anything.

Literally the only time I feel 'normal' is when I've had a benzo, or an opiate, or am just shitfaced pissed. But thankfully I'm not dependent on any of these things presently and never use on consecutive days. I feel like I'm becoming a bit hysterical. It's like I'm not really even human. I don't understand what motivates people to seek out friendship. I have lots of friends but I fucking hate them all. I hate people.

So I don't know what to do. I really don't want to get another benzo habit. But I feel so constantly purposeless. I'm like this non-human thing moving amongst real people. This may not be totally coherent as I'm a bit wasted but the problem is this, that, getting no reward from anything, I'm reduced either to total paralytic inactivity or to hysterical restlessness. In these circumstances it's difficult to justify not using sedative type meds. I'm constantly so afraid and wired. I'm never 'at ease', never.
 
Focus is a learned skill like any other, and takes a lot of practise. Doubly so when you're on medication that prevents stillness. That just adds to the challenge-- nothing in life worth doing is easy.

The thing that came to my mind first was meditation. Not of the mindfulness sort, although that may be of good use too, but of the 'sitting and quieting the mind' sort. Basically, take the thing that you are saying that you just can't do, and practise doing it whenever you can :)

Sounds pretty glib, no? The thing is, I've been in a similar boat to you, although not likely as severe. When I was unemployed and horribly depressed and anxious (before I finally broke down and got treatment that worked) I was very restless and antsy. It was very difficult, especially at first, but just taking a couple of minutes a few times every day to find a quiet place to just sit still, close my eyes, and focus on either the image of a flame (tough for me) or upon my breath (much easier-- a great place to start) really helped to bring the level of agitation down. If you have the means, two 10 minute sessions would probably be a great place to start, and you could take it from there.

There are TONS of sites online that offer advice on how to meditate, but if you had any questions as to the specifics feel free to PM me.

:)
 
Suessmayr, how long have you been on Lexapro? You had these symptoms for around the same length of time, or are they a more recent development?

I tried Cipralex for around 6 months after previously being on Cipramil ( Citalopram ). Both gave me a similar feeling of demotivation and lack of pleasure in anything. Seemed for me in stabilising my mood to prevent deep emotional lows, they also prevented any possibility of emotional highs. Felt like a zombie on them, and I stopped really interacting with people I'd previously enjoyed the company of because I felt completely cut off from myself, and them. I never found them overly stimulating but certainly there was a kind of restlessness on them moving from one unengaging activity to another that had previously held my interest trying to fill my day.

It may be worth talking to your doc and looking at other options. Mirtazapine is lots better for me. Cuts anxiety and elevates mood without flattening it altogether.
 
Ok, my advice might be a little unorthodox but buprenorphine (Subutex, Suboxone) might help. It is an opioid, but with a bit of a difference in how it acts on the brain. I don't know how much opioid tolerance you currently possess, but this could be a good choice, just figure out what dose works for you. It would help with the restlessness, and focus issues. It would also lift your mood considerably, and this would likely help you with your issues with avolition and anhedonia. Another option would be amphetamines, though they are toxic, they would help definitely in the short term as would methylphenidate or d-methylpehnidate. I'd get off the SSRI, and the bupropion for that matter, especially if you intend on switching.
 
I am alot like this, have been for months. I am constantly flitting from one thing to another without feeling any enjoyment or the ability to focus for long, I also rarely see friends now, I just don't have the desire to interact. I am hoping once I have had more cbt it might change matters. I too try to meditate as much as I can, have been doing for about 2 years to try and deal with my pain, if I didn't meditate to try and block it out I would constantly be in tears in bed.

Maybe give therapy and meditation a try alongside meds, maybe try a new anti depressant?

I know how you feel, it's not nice to constantly feel like this, I feel like I am constantly just trying to make the time pass so I can go to bed to try to sleep, I do not sleep well, I either can't fall asleep due to pain or I worry about not being able to sleep until I end up having a panic attack.

I know my advice isn't great but anything is worth a try.

Pm me if you ever want to chat or anything :)
 
really?
stop wellbutrin; in favor of meth/amphetamines, or ritalin/MDPV/etc?

talk about putting the cart before the horse... and before harm-reduction.... 8)

That buproprion is the last thing our intrepid SuessMeyer should consider stopping, especially if/when the SSRIs are discontinued. I shudder to think of the hit motivation & mood levels would take, especially considering how hard it is to come by for him already.

But really.... recommending amphetamines; even whilst knowing of it's toxicity & addictive potential, is just not wise at all...... nor is suggesting the use of an opiate intended for maintenance/taper treatment, in lieu of what the OP is already struggling with.
 
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Sounds like an akathisia reaction.
http://en.wikipedia.org/wiki/Akathisia

Here is a quick link to lexpro induced akithisia.
http://www.paxilprogress.org/forums/showthread.php?t=50284

It can happen as a side effect of the medication, or during withdrawal.
It is definitely considered a SERIOUS side-effect of medication, one NOT to be ignored.
It is even associated with a greater risk of suicide!
Any doctor worth a damn will advise you to begin tapering immediately.
I strongly caution against trying another SSRI until a 'wash-out' period has passed.
In general, I always recommend against SSRIs in the first place.

An entry from Wiki:
The 2006 UK study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as "agitation, emotional lability, and hyperkinesis (overactivity)".[11] The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia. Healy, et al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can "exacerbate psychopathology." The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebos showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).

A little information about serotonin.
It suppresses dopamine in 3 of the 4 dopamine pathways.
One of these pathways, the nigrostriatal, is involved in movement.
Loss of dopamine activity in this region is the cause of several movement disorders, such as Parkinson's, tardive disknesia, and akithisia.

Risk of these disorders goes up with stimulants and antipsychotic medications, which are powerful dopiminergic agents. But with SSRIs, this is rare and is a sign of altered serotonin transmission!

SSRIs are able to increase serotonin in the frontal lobes and prefrontal cortex, and in doing so target dopamine activity to the higher brain. They also increase dopamine in the central reward pathway.
But if they are suppressing dopamine in the striatum THIS IS A PROBLEM.

Continuing to take the medication may result in substantial increases in anxiety and restlenssness.
I have met many former SSRI users that claim they felt NO emotions while being treated.
There does appear to be some major benefits early on, but with time these diminish.

I have read that only half of patients end up 'cured' of depression from SSRI treatment.
The other half actually demonstrates a WORSE depression following withdrawal - and this is supported by evidence of HPA axis malfunction.

SSRIs can restore HPA function and regrow neurons in the hippocampus, but if some patients end up with worse HPA function after treatment, what has been 'cured'?

Anti-depressants may be quite risky to some people.
This has been the case ever since Prozac came out over 20 years ago.
The wellbutrin could be potentiating the dopamine toxicity, but the Lexapro is the culprit.

Keep taking the benzo, especially if you are going to taper/withdraw.
It may be the one thing that enables you to withstand the process.
Long-term benzo use is unwise, but they are fairly safe in short-term use.

If you are going to taper, you MUST involve your physician.
SSRI withdrawal must be done VERY gradually, but akithisia may call for a more rapid withdrawal that requires supervision. If your doctor shows no interest in withdrawal, find another doctor!

Even with a tapering schedule, SSRI withdrawal can be hell.
I know many people that took YEARS to recover their humanity.
They are the minority, but you need to know that it can be VERY bad.
If this is the case for you, the only cure is lots of time and exercise.

I STRONGLY recommend you stop taking lexapro.
FBC
 
It isn't just a side effect of SSRI's though, it is actually a symptom of a few different mental health disorders. I'd definitely try a different medication though as what you're taking doesn't seem to be of any benefit to you.
 
First Bad: AWESOME post! Thanks for the great info.

suess: any thoughts on what's been presented so far?
 
Yeah. Dave - I've often thought I should probably meditate. I was beginning to get into a habit a few months ago but stopped when all this jitteriness started. Now even the thought of sitting still like that makes me uncomfortable. Do you think I should just force myself?

Sepher; Doomed2Pain - I can relate strongly. I don't feel any inclination to do anything these days except go to sleep or get wasted. Not just a little wasted but so pathetically fucking wasted that my mind just shuts down and I pass out. I don't listen to music, read, enjoy food, enjoy company, enjoy movies or TV...there is literally nothing that I enjoy. I have to remind myself to masturbate and even then often just could not be fucked. I was on Avanza previously and it was admittedly much better for this, but it caused me to gain weight which I'm only just beginning to lose, so I don't want to go back to that. It seems like all the anti-depressants which are specifically indicated for anxiety (Paxil, Avanza, amitryptaline, imipramine) are associated with weight gain. Can anyone think of any AD's used for anxiety which do not cause weight gain?

Alex000 - I actually only recently got off buprenorphine after several years. So aside from using it occasionally, I'm not willing to go back there. Stimulants I would actually be willing to try - mainly because I never have before - but there is absolutely no chance of getting them from my shrink. He knows all about the previous benzo/opiate stuff and there is just no way he would ever write. I doubt he's even legally allowed to.
 
Venlafaxine is meant to be one that has less of a risk of weight gain, it's used for depression and anxiety. It didn't make me gain weight but also didn't seem to do much for my conditions so I changed to sertraline, again, no weight gain as of yet but no positive effects. Mirtazipine is renowned for weight gain, but it sent me batshit so I had to stop. Fluoxetine didn't make me gain much, just a little but my body was also new to being disabled so that could have been the reason rather than the drug. Again I found it didn't help me even after taking 40mg for 6-7 months. And yes force yourself to meditate but if you're struggling give up and try again later, it's what I have to do. Mood gym has some good meditation advice in the book, I bought it for my kindle last week.

Do you receive any counselling? If not I'd definitely look into it, along with a change of medication
 
suess-- give it a try. It'll take some effort, but I'd bet that it would pay off if you can stick with it.
 
What's Lexapro like? I was prescribed some aged 17 after speaking with my doctor for ten minutes. My mother took it off me though before I even begun taking it, she doesn't think I need anti-depressants. 8)
 
Well, glad to help.

Sue - a little more information...
A key component of serotonin function is the release of prolactin.
The hypothalamus is a relay station for the serotonin nerves extending into the frontal lobes, but it is also a control center for the endocrine system.
This includes the pituitary and adrenals.

Prolactin is typically released by the pituitary in a narrow set of circumstances, such as childbirth, breastfeeding, and orgasm.
It is a powerful hormone in the brain, directly impacting the central reward circuitry.
MDMA owes most of its 'magical' effects to the prolactin release that is seen after the peak of cortisol.

SSRIs also owe their effectiveness to prolactin, and the HPA or hypothalamus-pituitary-adrenal axis.
Prolactin is seen to increase over a period of many weeks!
And this long-term increase directly correlates to the effectiveness of treatment.

Many people taking SSRIs experience an increase in libido during the first few months!
Men can delay ejaculation for longer, and orgasms in both genders can be greatly improved.
Social interaction and libido also go up.
For a time.

It is very important to know that prolactin, normally released after orgasm, DOWN-REGULATES dopamine receptors in the Nucleus Acumbens.
This is the pleasure center of your brain's reward circuitry.
Prolactin occurs during orgasm and likely improves the sensation, but is also decreases sensation esp. in men.
It is a hormone that literally tells the brain to stop yearning for satisfaction, and it causes the satisfaction in the first place!

A MAJORITY of SSRI users experience sexual difficulty as treatment continues.
Loss of libido, ability to maintain erection in men or lubrication in women, and complete orgasmic anhedonia.
This can involve the physical act of orgasm, such as contractions, without the slightest bit of sensation or emotion.
Damn.

In a minority of SSRI users, this malfunction is know to carry on LONG after withdrawal.
The disorder is called PSSD, or post-SSRI-sexual dysfunction.
A visit to Yahoo group SSRIsex or paxilprogress.org will reveal relevant stories.

Good news: recovery is the trend, but can take as long as 1-2 years.
Bad news: a very small minority NEVER recover sexual function, even after 20 years.

What is going on?

Well, the 'epigenetic' theory focuses on the role of prolatin and dopamine in the Nucleus Acumbens.
The two actually fight each other, down-regulating the opposing receptors.
Prolactin is meant to be a very short burst of chemical, that temporarily disables dopamine transmission.

But SSRIs, and even MDMA, cause an extended prolactin response.
There is some evidence that even during WITHDRAWAL from these drugs, prolactin continues to remain at high levels!
As resilient as dopamine receptors are, it may be possible for the expression of genes to be altered in a long-term/permanent way.

Again, I must stress that even among the PSSD sufferers, recovery is the trend.
I have heard stories of people going well past ten years and still reverting to a 'horny' state.
Most people will make substantial recoveries within a year.
If it goes past two years, there is reason for concern.

The intent of this post is not to scare you.
I know you are at a very agitated state right now, and my sincerest wish is for you to CALM DOWN.
Take a DEEP breath.

And then try to understand that prolactin is both the key to SSRI treatment, and perhaps the greatest danger.
I do not speak about sexuality solely because you mentioned it.
Our sexuality is a KEY component of our humanity and it is tied to our most highly evolved cognitive abilities, found in the prefrontal cortex.
SSRIs wield the power to both activate the PFC, and to disconnect it from the rest of the mind!

I have struggled with libido and orgasm quality for most of the YEAR since I stopped using MDMA.
But I have to say, that there is an impressive constellation of psychological and social abilities that seem tied to sexuality.
This is reflected in PSSD sufferers - it is not only sexual complaints.
These people often refer to themselves as 'non-human'.
They struggle to even make eye-contact with others.
One woman I know claimed to have a 'pain-free' childbirth!

What is important to understand is that your sexual dysfunction is a sign that you need to stop the medication.
Come what may.

And the akithisia is your mind SCREAMING for relief.
You are actually damaging dopamine neurons in the movement center of your limbic system.

No worries.
There is a LOT of flexibility here.
It takes a 90% loss of dopamine before Parkinson's sets in!

And those dopamine receptors in the NA will most likely pop back up in no time.
It is the trend.

Listen to what your mind is telling you - stop the lexapro.
And expect to struggle.
You can do it.
 
sounds like the negative symptoms of schizophrenia to me, coupled with SSRI induced akathisia, get a referral to a psychologist and go on anti-psychotics as soon as possible before the positive symptoms kick in (they will really fuck you up and distort your thought patterns) unfortunately negative symptoms cant be treated by any known medications, but hang in there buddy it should lift :), with appropriate treatment of course
 
That's a Really informative post FBC I had no idea ssri's affected prolactin. Do other forms of anti depressants affect it too or is it just ssri's?

I've just been put on sertraline 5 weeks ago, but have found no positive effects yet, I have been on different ssri's too but not since April.

I felt like sues did even before I started medication though, hence why I put it down to my conditions (PTSD, adjustment disorder with depression and anxiety and panic disorder) I used to cycle between severe periods of feeling like that or I'd have a manic week and be really into projects, doing loads of artwork, planningthings etc but since may I've been stuck in the depressive part with odd episodes of psychosis. Psychiatrist didn't diagnosis bipolar though, but as he didnt see me in mania episode that may be why, I did mention it though.
 
The only real issue with sexuality is apathy. Everything is functional but I have virtually no interest in any of that. And tbh it seems like an unimportant issue.

It's difficult to know whether any of this would improve if I stopped the lexapro. My psychiatrist has told me that sometimes people stop a medication, deteriorate, and then find that even if they start back up again they get no response. I really don't know what to do.

I can't remember the last time I did anything. I used to have so many interests and be so active. Now I literally don't do anything other than what I absolutely have to. Is anything indicated for anhedonia?
 
I think you should discuss it with your psychiatrist and see what he suggests. I'm still giving therapy and different medications a try, if I keep trying I am sure to find something that works, sucks that it has taken so long already but I'm trying my best to stay as positive as I can. It's hard and some days I fall into a pit of despair but I do try my best to stay positive.
 
Yeah; if this is something that you've only noticed since starting lexapro, you really should discuss is with your prescribing doctor. Mention that, at the very least, you will be at the risk of non-compliance if the side-effects get too bad.
 
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