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#1 brzghoff

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Posted 13 September 2014 - 07:45 PM

my experience with anti-depressants, cymbalta and my eventual withdrawal and current discontinuation status is unique to me. my experience is not indicitive of what you may have experienced or may experience in the future.

 

i know this is long, but the background is important in understanding the decision i face. a major complicating factor is that i am about to leave the state for a month - without my mental health support system. 

 

its been 17 weeks and 2 days since i last took cymbalta. i did a modified taper that was really just a variant of cold turkey. for the majority of the past 17 weeks life has been rough compared to what life was like on cymbalta.

 

with the help of my therapist i have come to the conclusion that the anxiety that developed after i quit the C stems from the same source as my original depression diagnosed in 1996. i had come a long way in managing my depression while on meds. i had been on doses as high as 90 mg but was on only 30 mg of the C for the year prior to quitting. at the beginnng of the year i felt fine, i had a great attitude toward my life and my relationships. i had a lot of respect from colleagues, friends and family for my upbeat and grounded point of view towards life.

 

i think i may have been overconfident in my decision to quit the C. my therapist supports me in whatever i decide for myself. i am thrilled with the improvement to my physical health. on the other hand, my mental health has deteriorated significantly. here and there i have had multiple days in a row of relative normalcy but the majority of my days off the drug are filled wth a cycle of mild to moderate anxiety with ocassional severe spikes. 

 

i've come to the point where i am not sure whether to continue to fight the good fight to recover exclusively through focusing on cognitive skills or add some kind of med back into the mix. i have been on the mood stabilizer lamictal all along and that is not going to change. i have an excellent therapist. i will say that in social situations, while in public or while engaged in certain activities the anxiety drops to almost nothing. its at its worst when i am home which is most of the time these days. part of the reason is that my husband and i are around each other for most of the day. we love each other very much and are the best of friends - but we can't be around each other all day long.  fortunately he is gone at work right now.

 

i quit for a variety of reasons. i had side effects that included high blood pressure, weight gain and high cholesterol. since stopping i dropped 20 lbs in about 6 weeks. i am 5'4" and barely 120 lbs. my cholesterol dropped to 195 and my BP is stable on a much lower dose of a much weaker bp med. the other side effects were inconvenient and annoying but not a disruption to my day to day experience. certainly nothing nearly as bad as how i have felt since i began my taper at the end of march. 

 

the more practical reason for quitting was that my insurance would no longer cover the C or any brand name. i had the time and opportunity to quit. i left my job by choice at the end of february

 

since coming off cymbalta its all about anxiety. all other side effects i have experienced are symptoms of anxiety. i never really dealt with anxiety before the withdrawal. in 1996 i was put on anti-d's. while anxiety is a symptom of depression, it was never a biggie for me. i worked in a very stressful and competitive industry and continued to excel professionally but at home i was falling apart... the classic crying, irritablity, rages, excessive sleeping and the ever present sensation of walking through water. i was living a double life

 

i know i need to consult a psychiatrist. i "fired" the one i had and haven't gotten a new one. it takes 2-4 weeks to get into see one. not gonna happen. in less than three days my husband and i are leaving for out of state

 

i would prefer not to go back on another anti-d. i've taken zoloft which pooped out after 6 months. that was in 1996, maybe sertraline would be a good choice today? i don't know. wellbutrin almost destroyed my memory and my ability to to think clearly and communicate. i took effexor for awhile but in 2004 my psych decided that he thought the C would be a better choice. i was on cymbalta for 10 years before i quit this spring. my insurance does not pay for any brand name drug and  minimally covers many generics. i've thought about buspar but don't know anyone who's taken it. and no, i will not take benzos. addiction = anxiety.

 

i am facing a month away from my established home in just a few days and am not sure where to turn. its a little scary. 


#2 FiveNotions

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Posted 13 September 2014 - 08:00 PM

hmmmm .... this is definitely important, Brzghoff, and I'm glad you took the time (and the energy!) to share a bit more of the background and context for the issue / decision you're facing ... I need to re-read your post here, and go back and re-read your earlier posts ... and mull on this for a bit before I respond ... lots to think about ... and I'm sure this adds to your sense of anxiety ...

 

The one thing came to mind immediately with respect to going back on Cymbalta, or any other ssri is this ... they all have a "ramp up" period of several or more weeks ... so there's no way you can get on a new one and get it fully active in your system before you leave for the month away ... it might not be fully in effect until you get back, or even a bit longer ....

 

I'll get back to you tomorrow morning ... in the meantime, rest assured, the others will be arriving to help! :)


#3 fishinghat

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Posted 13 September 2014 - 08:05 PM

I take buspar and have for many years. Few side effects. No significant withdrawal BUT limited help. It is a very week drug but low risk, You might consider clonidine and/or hydroxyzine. Very effective and immediate help. Both can cause a lowering of BP. Most times this only last a week or two. NO WITHDRAWAL for hydroxyzine. One should come off clonidine over a couple week period as you do have an increase in BP and pulse. Nothing compared to an ssri or snri.


#4 brzghoff

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Posted 13 September 2014 - 08:15 PM

I take buspar and have for many years. Few side effects. No significant withdrawal BUT limited help. It is a very week drug but low risk, You might consider clonidine and/or hydroxyzine. Very effective and immediate help. Both can cause a lowering of BP. Most times this only last a week or two. NO WITHDRAWAL for hydroxyzine. One should come off clonidine over a couple week period as you do have an increase in BP and pulse. Nothing compared to an ssri or snri.

 

 

since i am on lamictal maybe the buspar would be enough? while i never spoke with someone who's been on it i heard that it works well when paired with an anti-d. while lamictal is a mood stabilizer not an anti-d - it does help prevent the "low" mood swings.

 

 

 clonidine also used to treat HBP? maybe i could kill two birds with one stone. any other side effects?


#5 brzghoff

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Posted 13 September 2014 - 08:18 PM

hmmmm .... this is definitely important, Brzghoff, and I'm glad you took the time (and the energy!) to share a bit more of the background and context for the issue / decision you're facing ... I need to re-read your post here, and go back and re-read your earlier posts ... and mull on this for a bit before I respond ... lots to think about ... and I'm sure this adds to your sense of anxiety ...

 

The one thing came to mind immediately with respect to going back on Cymbalta, or any other ssri is this ... they all have a "ramp up" period of several or more weeks ... so there's no way you can get on a new one and get it fully active in your system before you leave for the month away ... it might not be fully in effect until you get back, or even a bit longer ....

 

I'll get back to you tomorrow morning ... in the meantime, rest assured, the others will be arriving to help! :)

 

 

also, what i neglected to mention is that i found three 30 day bottles of 30mg cymbalta the other day. the PO had lost a mail order 'scrip package last year. the pharmacy replaced it and the original package arrived a couple months later and its been hanging around ever since. doesn't expire until december - but i really really really don't want to take it. i won't take it. i won't. 


#6 fishinghat

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Posted 13 September 2014 - 08:19 PM

since i am on lamictal maybe the buspar would be enough? while i never spoke with someone who's been on it i heard that it works well when paired with an anti-d. while lamictal is a mood stabilizer not an anti-d - it does help prevent the "low" mood swings.

 

 

 clonidine also used to treat HBP? maybe i could kill two birds with one stone. any other side effects?

 

The other common side effect of clonidine is dry mouth


#7 brzghoff

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Posted 13 September 2014 - 08:28 PM

The other common side effect of clonidine is dry mouth

 

that's okay, its a major side effect of most anti-d's especially when ramping up. i've used biotene toothpaste and mouthwash for years ;-)


#8 FiveNotions

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Posted 13 September 2014 - 08:31 PM

ok, I'm back after some re-reading of your posts ... a few questions ...

Have you had this anxiety for the full 17 weeks and 2 days you've been completely off the Cymbalta? If not, about when did it appear?

Has the intensity, length of episode or frequency of episodes changed or remained the same during this time?

And, am I understanding you correctly, that the anxiety doesn't hit when you're "out and about," just when you're home? Does it hit when you're home alone, or just when you're there with your husband? Does it ever hit when you're "out and about" with your husband?

I thought you were taking clonidine, and didn't find it helpful? (Maybe that was Gail?)

Have you ever taken a benzo? I totally get why you don't want to take them, just wondering if you've had a prior run-in with them like I had (physically addicted, awful to get off of).

#9 Carleeta

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Posted 13 September 2014 - 08:43 PM

Brzghoff...What a wonderful detailed post..Thank you for giving such an insight on your life up to date... Fishinghat is the most knowledgeable with the med scene...FiveNotions is wonderful with the research. As for me adding anything; all I can say is a friend of mine is on Buspar and has been for years and years and it has definitely helped her...Her diagnosis is more on the depressive side...She has tried many meds prior to Buspar with no luck..

It's understandable your concern and anxiety especially since you are returning to your home in NC in about a month, without you mental Health support....This woukd surely bring on more anxiey than you need...Although what you do have is a support person with you, and that us your husband..He will be safe for you and keep that in mind..

Please let us know what decision you make. ..

#10 brzghoff

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Posted 13 September 2014 - 08:51 PM

FN:

 

the anxiety started about two weeks after i stopped, basically about the time the C itself was out of my system. 

 

intensity length and frequency varies a lot. however, from week 2 to week 6 was the absolute worst wthout a doubt. i would get relief, but there were times of outright terror. i don't know how i survived. those i guess could be considered panic attacks, but i wasn't hyperventilating or anything - didn't last but about 15 minutes. that's when i started using benedryl - just a 25 mg pill or two in any single day. i have allergies too so it was a dual purpose opportunity. week 13 was the best week ever, virtually no isses. i can't think of anything that was different during that time. the week just before that i was coming apart and the week after and ever since its been kinda rough off and on.

 

it has only hit me once when i was out and about -  at a restuarant earlier this week. never before then. that was highly unusual. when it usally happens i am at home and yes, most often when my hubby is home. it has a lot to do with my reaction to him. he is a wonderful man, don't get me wrong. he just obsesses a lot about all the stuff he needs to fix on the house and it triggers my anxiety. i really need to get a job to get me out of the house. i just can't yet. we have the month away.  hubby is better about obsessing, but i have to work on the cognitive stuff to stop the automation of the anxiety. he's gone with me to the therp. 

 

clonidine? no. must be gail

 

i've taken benzos in the past, but not for exisiting anxiety, but to prevent it - for MRI's. i have seen xanax addiction in a few friends. not going there. 


#11 brzghoff

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Posted 13 September 2014 - 08:53 PM

carleeta

 

thank you for your kind words. also for your report about your friend on buspar. honestly, just knowing there are options is a huge help. 


#12 brzghoff

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Posted 13 September 2014 - 08:57 PM

FN: let me clarify, there was anxiety during the initial withdrawal phase, but nothing like what kicked in at 2 weeks off.


#13 FiveNotions

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Posted 13 September 2014 - 09:20 PM

We're so very, very fragile when we get off the poison ... and you're just a bit more than 4 months off ... plus, you had some cold turkey thrown into your withdrawal mix ... I'm not at all surprised that the anxiety has appeared. (It appeared for me at about 5 months off.)

And yes, I believe that anxiety can be contagious ... in the sense that when those of us who are prone to it are around other anxious or ocd folks, our own stuff starts acting up. For example, my best friend, who has tried to be so good to me during withdrawal, is a bit OCD, and when I'm with him for too long, my anxiety starts to ratchet up.

You said that your husband, he's a "trigger" for my own anxiety ... and you're going to be mostly with him for the coming month, yes? Is this at the heart of why you're worried about the trip and thinking about going on another med, or even the Cymbalta?
 
Is your husband getting his own regular therapy and/or taking any meds to manage his "stuff"?

It almost sounds like you're trying to fix yourself so that you can adjust to him... this is worrisome to me ... I'd hate to have you decide to go back on Cymbalta just to manage anxiety that occurs only when you're with your husband...

I'm glad I was wrong about you taking clonidine and it not working, because I think it's definitely worth trying ... it's working wonderfully for me ... and it's helping with my somewhat elevated bp (normalized after I got off Cymbalta, then recently started edging up a bit...possibly due to the anxiety ... one big circle) ... it's lowered the bp to the point where I've talked to FH about switching to the hydroxyzine ... still mulling on that ...

As for the benzo option ... a doc I had years ago let me get addicted, never told me about "tolerance" and let me have it "PRN" ... so yes, I had a bad run-in with it ...

However, properly used, as FH has taught me, benzos can be very helpful ... I tried lorazepam briefly this spring, and wanted off of it because, like you, I didn't want the addiction issues ... I was switched to valium/diazepam ... and just a small dose (1 mg twice a day) has worked well for me... but I'm not using it much at all anymore, because the clonidine does such a good job. I do, however, have a bottle "on hand, just in case."

You might want to consider getting on either the clonidine or the hydroxyzine, and also have a benzo rx on hand, in case the anxiety gets really bad.

#14 brzghoff

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Posted 13 September 2014 - 10:21 PM

yes, it will be just us two for the month at our other home. we're planning to do some hiking and camping, so we won't be at the house the whole time. we have some acquaintances there so there will be social activities, but not a lot. 

 

when the big anxiety hit it was at beginning of june - when we were up there. i have some bad memories from that time and am working on focusing on all the good things that i've experienced at that house - they most certainly outweigh the bad. 

 

since i don't have a psych right now i am going to try and get a last minute appoint with my PCP on mon. we leave tues. i'll see if he'll write me a 'scrip for clonidine. i am guessing he will tell me to stop my current BP med, losartan, if i take the clonidine. 


#15 FiveNotions

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Posted 13 September 2014 - 11:40 PM

Found a couple of articles about stress/anxiety being "contagious" ...

Stress can be as contagious as germs
http://www.startribu.../239506811.html

Science Says Stress Is Contagious
http://time.com/8408...ess-contagious/

#16 thismoment

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Posted 13 September 2014 - 11:57 PM

brzghoff

It's clear you don't want to go on this trip. Also, your husband is the link to your anxiety, and the prospect of that month away from your established home (and alone with him) has frightened you, and you feel it will trap you-- have you and he gone to therapy together?

Don't go on the trip, but do plan to go to therapy with your husband.

#17 brzghoff

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Posted 14 September 2014 - 07:27 AM

 

FH don't get me wrong, i most definitely DO want to go on this "trip". we have things planned that i DO want to do and am looking forward to. things where anxiety does not get in the way - actually helps me improve, like camping/hiking and the social things we have planned. getting out of this place is good for me. while i had stress/anxiety at the house up there in june, i've had way more down here! i will be with my husband wherever i go. i wouldn't dream of being away from him for a month. the anxiety is mine. he is also working on his. he's come with me to therapy on several occasions and we always get more out of it to work on - just like when i go alone.

 

we also have prospective renters lined up to view the house while we are up there - as we plan to rent it when we leave. that's part of our income. thats part of my contribution to our enterprise. it's always rented when we are not up there. i enjoy that process and i do not stress over it. 

 

my concern was how i approach my recovery recognizing that i won't be near my doctors. i can always call the therapist for a phone appt no matter where i am. i plan to get my PCP to work in an appt on monday. 


#18 FiveNotions

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Posted 14 September 2014 - 10:55 AM

Good morning, Brzghoff! Thank you for your last post, it adds the key point to your original post yesterday, which I think I misunderstood, in that I didn't focus on the aspect of you being away from your med support network, but focuses on the anxiety in context of how you feel at home/away from home etc. Now I get it, and I apologize for going sideways on you! :(

It's excellent that you can get your therapist via a phone appointment, that takes care of a significant part of the network. (Man, you are so lucky to have that option!) I assume he knows that you're going to be away for a month? If not, another be sure to let him know, ideally if you can do so before you leave, or call him as soon as you get there.

As for your PCP and what to do while away ... get in to see him tomorrow, even if you have to do a "walk-in/sit-in" in his office ... and tell him you concern about being away. Ask him if he has any suggestions for what to do.

Here's another idea, that a friend of mine and his wife did last year, to make arrangements for themselves during a two month vacation when staying in a rented house in a resort area. It worked for them, maybe worth a try for you.) ... Check your insurance company's coverage for the area where you'll be, call the company to ask about providers there, and, if necessary, find out about their "out of area" coverage for docs not in their network. You can try to get the names / contact info for a couple (or several) docs where you'll be, and try to make an appointment with them for while you're there, etc.

Another option is to identify/locate a couple of the fee-based (pay as you go) urgent-care walk-in clinics / doctors that are springing up around the country as a result of obamacare. There are at least a dozen of them here in DC, and I've read excellent things about their quality of service ... basic, yes, but still decent. (I also used one years and years ago, when I was traveling with my ex...he got a horrid eye infection, and refused to go to an ER where we were. I found one of these places in the local yellow pages, drove him there, and he got looked at and given an antibiotic rx within an hour.)

And, last but not least, you have us! Take your ipad, tablet or laptop with you, and stay in touch with us as often as you can / need to. :hug:

 

Also, please just try not to overdo ... I remember how exhausted you got several months ago, while working on the house fix-up/clean-up (I think that was the project?) ... try to maintain an even-keel ... enjoy everything you can, but in such a way that you avoid, if at all possible, the "relapse days" that we often get after a "great day." (Listen to me, giving advice about something that I never fail to do ... overdo and then relapse ;) )


#19 brzghoff

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Posted 14 September 2014 - 11:25 AM

 

thanks a lot,

 

i thought about going to a doc up there, yes my insurance is portable - used it that way already for minor stuff. wasn't sure how comfortable docs are about 'scribing certain psych meds when they don't know me, i know an ER will, but i absolutely will not go that route - they want to lock you up for a few days! ;-)

 

thank all of you for your help, i have a good idea on meds to ask about now. i really think i can get through this and knowing there are some options with lower side effects and no or manageable withdrawal symptom is great, i feel better already! got good sleep lat night and that helped too - thank you benadryl! 


#20 FiveNotions

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Posted 14 September 2014 - 11:41 AM

Brzghoff, know what you mean about ERs... bad enuf with the ones near home ... going to one while away, nuh uh!

One other thought about both your therapist and your PCP, especially the therapist. How about scheduling an appointment for immediately after you get back? That might give you the comfort of knowing you're "network" will be ready and waiting for you to check in and "de-brief" at then end of your time away.

I still think you should consider asking your PCP for a small number of benzos ... maybe just 5, 10 or 15 ... to take with you in case something goes "haywire" and you absolutely need to pull the anxiety back under control quickly. Given how strongly you've stated your desire not to use this stuff, I think you're quite safe to at least have a bit of it on hand.

And, subject to what FH, our benzo expert dude, thinks ... my suggestion would be to get a few pills of a benzo other than valium. Valium has a long half-life, and takes a while to ramp up in the system. It worked great for me because I was on it steadily for a period of weeks, then gradually weaned down/off ... you're need, if it even occurred, would be for something that kicks in more quickly, just enuf to deal with a particular situation/day ... a small time frame. The benzos other than valium all work more quickly, and have much shorter half lives. (That's why use of them over extended time periods results in tolerance, need for increased doses, etc.)

#21 gail

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Posted 14 September 2014 - 04:53 PM

Bon voyage BRZ,

The fact that you do want to go and are looking forward to doing enjoyable things is a good sign.

I am not worried here, this is shitbalta discontinuation side effects.
You were not prone to that before.

You are only at four months, give it time. Meanwhile, benadryl helps you sleep,at least that is another positive.

As I said, bon voyage!

#22 brzghoff

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Posted 15 September 2014 - 11:52 AM

 

thanks for all your help. went to my PCP's office this morning. he actually wasn't there today but i saw his PA, never met him before but very nice and thorough on making sure he understood. we discussed options and side effects as well as how different meds work. we decided the clonidine would work the best for my situation and i got a scrip to pick up. he also said that i can feel free to call while i am gone and we can make adjustments/changes if needed. i already have a pharmacy up there so i'm set with 'scrip transfers and them having a record of my meds/history. 

 

after getting all your feedback and having a plan in place, my anxiety dropped a lot. while last week was rough overall i think my high anxiety friday and saturday was the result of getting very little cumulative sleep. sat night i took a benadryl and at least got some sleep and felt much better yesterday. so much so that i went to sleep last night without anything to make me sleep - nothing! and i slept nine straight hours!!!!!!! today i woke up feeling almost normal and have managed to get a lot done without overdoing it. 

 

i feel good about our trip and have something positive to look forward to. we leave in the morning!

 

thanks again all!


#23 FiveNotions

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Posted 15 September 2014 - 11:58 AM

Brzghoff, once again I'm outa' likes (what is the deal with that?) ... But like, no love your post!!

 

Good news on the clonidine ... what dose did he start you at? And is it 2 x day?.

 

About the sleep ... yeah, amazing isn't it what a good night's sleep (or several) can do for how we feel? Lower anxiety, more positive, more energetic, more hopeful ...

 

Have a wonderful trip, hope you can take your ipad with you so you can stop in here occasionally to say hi and let us know how it's going!


#24 fishinghat

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Posted 15 September 2014 - 12:01 PM

Good luck on your trip Big B. Don't push it too hard or it may come back to bite you. Easy does it.


#25 brzghoff

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Posted 15 September 2014 - 01:03 PM

 

i go and pick up the 'scrip later today, not sure the dosage, i can start with one at bedtime and see how it goes. up to 3x daily if needed. if i take it that much i have to skip my losartan (bp med) every other day and need to monitor regularly to make sure it doesn't drop too low. i'm counting on not even having to start with the clonidine, but if i do need it, i've got it. 

 

yep, the macbook is going. we do lots of biz over the internet these days


#26 fishinghat

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Posted 15 September 2014 - 03:05 PM

Big B

 

Let me know the dose after you pick up the med. I am curious.


#27 brzghoff

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Posted 15 September 2014 - 04:57 PM

 

got back, pharmacy screwed it up but i finally got it "righted". the scrip is .1 mg x 3 daily. if i want. i had asked the PA this morning if it would be effective if i started out taking it just once a day - in the evening - since that is when anxiety tends to start building. my biggest concern with anxiety is getting to sleep. he said that is fine its just that i am able to take it up to 3 times a day as needed. i am really cautious about taking a new drug. he also added that if my blood pressure ever drops below 100/60 to skip the losartan the next day, but not to stop taking it altogether. 

 

today has actually been a great day, i don't have "plans" to start taking it tonight. i'll just wait and see how things progress. 


#28 fishinghat

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Posted 15 September 2014 - 05:10 PM

Big B

 

Your dr gave you the standard starting scrip for anxiety and you and your pharmacist were right about just one at bedtime to begin with. Most dr give you those instructions anyway. By taking one a day to begin with it gives your body a chance to adapt to the sleepiness that occurs in the beginning. Eventually you will need two a day at minimum to handle the anxiety.

 

I look forward to your keeping us posted.


#29 FiveNotions

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Posted 15 September 2014 - 05:43 PM

Bryzghoff, do you have one of the home "do it yourself" bp kits? I have both the old fashioned arm cuff, and one of the wrist cuffs. I take the wrist cuff with me whenever I leave the apartment.

#30 brzghoff

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Posted 15 September 2014 - 06:03 PM

yes i have a BP cuff - old school style. when i was on the C even though i was taking benicar for BP it still spiked to ungodly levels. 





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