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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4447
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Ive been on Cipralex for two years, first six months at 10mg,

Customer Question

I've been on Cipralex for two years, first six months at 10mg, then upped to 20mg/day. It was my first foray into pharmaceutical treatment; I was 26 and in recovery from a sexual assault, which had spawned a few psychotic episodes and terrible depression. It got rid of my anxiety and panic attacks, except the couple times I fell off the wagon and had alcohol (I've been sober for 2.5 years). The depression rose and fell as usual, but without the anxiety became manageable with my general mindfulness and routine.

Since mid-summer, I've noticed my moods have become much more erratic again, with huge bursts of energy and productivity and then short crashes of exhaustion. I assumed it would just go away, and was a function of lots of sunshine, but it's just been getting worse. Today, I had my first panic attack in over a year. I do not feel depressed currently; in fact my life is wonderful and I am generally positive about the improvements I've made in the past couple years. I'm doing everything right; I don't really understand what's going on.

I've never been diagnosed, as my care has always been somewhat temporary due to budgetary restrictions; I've always had issues of anxiety, depression, self-harm, self-medication, but the sexual assault aggravated them to a point where I recognised I needed medical help.

I have an appointment with the doctor who I saw regularly my first year on Cipralex later in the month, but I'm wondering if I should push to have one sooner. I'm not very good at calculating when I need help.
Submitted: 9 months ago.
Category: Mental Health
Expert:  Dr. Z replied 9 months ago.

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I am so sorry that you have been experiencing these symptoms of what appears to be anxiety currently, I can imagine how distressing this is for you.

Dr. Z :

I would like to ask a couple questions to get some more information, so that I can better assist you.

Dr. Z :

Do you take the Celexa once or twice a day?

Dr. Z :

Have you been to therapy at all for your symptoms?

Dr. Z :

I am sorry I read that wrong, you mentioned Cipralex. Are you taking that once or twice a day

Customer:

I take 20mg of Cipralex once a day in the AM. When I first started it at 10mg, my doctor recommended I take it at night but I couldn't sleep.

Customer:

Yes, I do regular counselling at my university, once a month.

Dr. Z :

Well the lack of sleep with the Cipralex will happen usually as you first get used to the medication, but since you have taken it for so long, most likely this temporary side effect will not occur with you. So you may want to consider taking 10mg in the morning and 10mg at night to avoid those high energy and crashes of exhaustion that you have during the day

Dr. Z :

Also another good medication that can help with anxiety are benzodiazepines (e.g. Ativan, Xanax, Klonopin) that you can ask your doctor about. These are effective within an hour or two after use. But they can be physically addictive, so it is best to use it as needed

Dr. Z :

Benzodiazepines also work really well for panic attacks too

Dr. Z :

Also if you Cipralex is not as effective as it used to be. Sometimes the addition of a low dose of Abilify or Remeron can help increase the effectiveness of the Cipralex for you

Dr. Z :

In addition, I can teach you some really good Cognitive Behavioral Therapy (CBT) techniques that can help manage your anxiety better too. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Customer:

Yes, I have a history of addiction and overdose, so maybe not benzos. The morning and evening is a good thought though. Should I try that before talking to my doctor, or wait?

Dr. Z :

You can try the morning and night dosage before talking with your doctor, there is no risk to it. Also another good non-addictive medication for anxiety/panic attacks is called Gabapentin that you can use as needed too. So that can be something to ask your doctor about as well

Dr. Z :

Also I would like to teach you some good CBT techniques that can help with anxiety and depression too, since you mentioned that you have a history of depression

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help you keep track of any negative thoughts you have. You put the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want you to come up with an alternative thought for the situation (more objective and plausible). This will help you change your way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

Dr. Z :

In addition, these two worksheets are very good at helping lessen anxiety symptoms. It can help you focus on the big picture and the objective/positive thoughts and outcomes.

Dr. Z :

Also individuals with anxiety have a poor coping mechanism, so this worksheet will help you develop a better coping strategy to manage your symptoms better.

Customer:

:) You're very sweet. I dig CBT. I find it very helpful, and the cipralex made it much easier to use.

Dr. Z :

Yes CBT is great and I think if use the self-help techniques more than once a month it will be very beneficial for you.

Dr. Z :

Here is also a good CBT website I use with patients as well

Customer:

Do you think getting a diagnosis is important? I've always resisted it, but as I get older and see patterns, and I wonder...

Customer:

I've used moodgym before! It's nice. Thank you for all the links.

Dr. Z :

Well a diagnosis is just a name, it will not really effect treatment so much. But right now I am leaning towards Anxiety, but these could be unresolved issues related to Post Traumatic Stress Disorder (PTSD) from your sexual assault.

Dr. Z :

Still no matter the diagnosis, we would treat the symptoms that concern you the most presently and that is anxiety

Dr. Z :

Also these books maybe helpful too

Dr. Z :

May I ask, why have you been resistant to get a diagnosis?

Customer:

Thank you. I was a messed up kid, dropout, runaway, etc etc, but now I'm quite successful, in grad school, with amazing relationships. I've worked hard and when I have a relapse, it feels like all is going to fall apart. Thanks.

Dr. Z :

I think you should definitely applaud yourself for what you have accomplished, that is very impressive! These anxiety attacks that you have are minor bumps in the road, they do not define you or control you. With the treatment you are able to control them and overcome them. Try the techniques and splitting the dosage of your medication and see if that helps

Dr. Z :

Also this is a link for something called Progressive Muscle Relaxation that can help you create a long term calm by using muscle tension and release techniques; it can help manage your anxiety and depression and is very similar to a style of meditation.

Customer:

My first boyfriend was institutionalised and diagnosed bipolar and schizophrenic, and I watched and tried to help him through a barrage of treatments and after 2.5 years of that abusive relationship, I had a bad taste left in my mouth. I had seen my own therapists during that time and I was so angry.

Dr. Z :

I am so sorry that you had to suffer in an abusive relationship for 2.5 years, I can imagine how that would make anyone angry. But it seems like you have really grown and have truly overcome this, which is something to be proud of.

Customer:

I try my best.

Dr. Z :

And all the more reason why you should not think that you will fall a part from these relapses

Customer:

:)

Dr. Z :

I know you do, and you are doing a good job. It is hard, but you are persistent

Customer:

Yes. It just reminds me of all the miserable times. Can be hard to stay focused.

Customer:

Thank you for talking to me. I hope you make good money for this.

Dr. Z :

Oh thank you for the compliment, I actually only make money when you rate me. But we can continue to talk if you like, or if you have any other questions or concerns

Customer:

I won't take up anymore of your time, as I'll probably just end up flirting with you. I'm going to overshadow my sorrows in American Horror Story.

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4447
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and 2 other Mental Health Specialists are ready to help you
Expert:  Dr. Z replied 9 months ago.
Haha, again thank you for the compliment, but you can talk to me about anything. And the first episode of the new season of American Horror Story was good! I wish you all the best with your treatment and I hope these symptoms go away swiftly for you. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

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