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What Causes Severe Anxiety And Restlessness?
Question: Hello
I am suffering from episodes of extreme agitation. The episodes are so extreme they are like torture. They last for several hours at a time.
I believe the cause of the agitation is down to a side effect of clonidine and/or topiramate that I take. (I was until recently on 1.2mg/day of clonidine and 200mg topiramate.) Agitation is a side effect of both of the drugs, especially clonidine. (I would be interested to know if you agree with me that clonidine is most likely the cause of the agitation.)
What I would like is for you to please list for me some drugs that I could get prescribed by a UK GP / psychiatrist that I could take that would wipe out the extreme agitation when it strikes. For the drugs that you list please ensure that they would work instantly for extreme agitation (and not require weeks to be built up in system) and that they can’t cause dystonia because I had this problem with haloperidol and don’t want to go through the same thing again.
The drugs I have already tried are listed below:
Antidepressants: Mirtazapine, phenelzine, tranylcypromine, dosulepin, amitriptyline, citalopram, escitalopram, fluoxetine, sertraline, venlafaxine, lofepramine
Antipsychotics: Risperidone, olanzapine, quetiapine, aripiprazole, haloperidol
Benzodiazepines: Lorazepam, clonazepam, diazepam, alprazolam
Beta blockers: Propranolol
Anticonvulsants: Sodium valproate
Other: Buspirone
None of the above medications have helped in the past with the exception of the benzodiazepines, which I now have a tolerance to.
Also, I would like advice on how to come off topiramate. I currently am on 150mg. I wish to come off the drug as fast as possible but without incurring any of the severe withdrawal symptoms.
Many thanks
XXXXXXX Harris
I am suffering from episodes of extreme agitation. The episodes are so extreme they are like torture. They last for several hours at a time.
I believe the cause of the agitation is down to a side effect of clonidine and/or topiramate that I take. (I was until recently on 1.2mg/day of clonidine and 200mg topiramate.) Agitation is a side effect of both of the drugs, especially clonidine. (I would be interested to know if you agree with me that clonidine is most likely the cause of the agitation.)
What I would like is for you to please list for me some drugs that I could get prescribed by a UK GP / psychiatrist that I could take that would wipe out the extreme agitation when it strikes. For the drugs that you list please ensure that they would work instantly for extreme agitation (and not require weeks to be built up in system) and that they can’t cause dystonia because I had this problem with haloperidol and don’t want to go through the same thing again.
The drugs I have already tried are listed below:
Antidepressants: Mirtazapine, phenelzine, tranylcypromine, dosulepin, amitriptyline, citalopram, escitalopram, fluoxetine, sertraline, venlafaxine, lofepramine
Antipsychotics: Risperidone, olanzapine, quetiapine, aripiprazole, haloperidol
Benzodiazepines: Lorazepam, clonazepam, diazepam, alprazolam
Beta blockers: Propranolol
Anticonvulsants: Sodium valproate
Other: Buspirone
None of the above medications have helped in the past with the exception of the benzodiazepines, which I now have a tolerance to.
Also, I would like advice on how to come off topiramate. I currently am on 150mg. I wish to come off the drug as fast as possible but without incurring any of the severe withdrawal symptoms.
Many thanks
XXXXXXX Harris
Brief Answer:
Further details required.
Detailed Answer:
Hello
Thanks for using Healthcare Magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
However I would like to know a few details before I can proceed to help you.
1. Please describe the incident of agitation. What actually happens during such episodes.
2. What goes through your mind during such episodes.
3. Are you oriented to the time, place and people around you during such episodes.
4. Do the episodes end abruptly.
5. Do you take any recreational drugs?
6. How much sodium valproate have you used?
7. Do you feel anxious during such episodes.
Hope to hear from you soon.
Regards
Dr Srikanth Reddy
Further details required.
Detailed Answer:
Hello
Thanks for using Healthcare Magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
However I would like to know a few details before I can proceed to help you.
1. Please describe the incident of agitation. What actually happens during such episodes.
2. What goes through your mind during such episodes.
3. Are you oriented to the time, place and people around you during such episodes.
4. Do the episodes end abruptly.
5. Do you take any recreational drugs?
6. How much sodium valproate have you used?
7. Do you feel anxious during such episodes.
Hope to hear from you soon.
Regards
Dr Srikanth Reddy
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your reply.
To answer your questions:
1. During the episode of agitation, I feel extremely agitated and when sitting down my legs jump up and down (I think in trying to cope with the level of adrenaline going through my body - I'm not sure).
2. I feel terrible, and I just want the agitation to stop.
3. No.
4. I can't recall.
5. No.
6. I can't remember but I believe this drug requires you to built it up in your system and that is not something I have time to do. I am looking for something that will work immediately when an episode of extreme agitation, which could happen at any moment now, next strikes.
7. Not really.
What I don't understand is if it is the clonidine that is causing the agitation, why did I only develop the episodes of extreme agitation after several months of being on 1.2mg? Why did I not develop the episodes a few days/weeks after being on the 1.2mg dose? Can you explain that?
To answer your questions:
1. During the episode of agitation, I feel extremely agitated and when sitting down my legs jump up and down (I think in trying to cope with the level of adrenaline going through my body - I'm not sure).
2. I feel terrible, and I just want the agitation to stop.
3. No.
4. I can't recall.
5. No.
6. I can't remember but I believe this drug requires you to built it up in your system and that is not something I have time to do. I am looking for something that will work immediately when an episode of extreme agitation, which could happen at any moment now, next strikes.
7. Not really.
What I don't understand is if it is the clonidine that is causing the agitation, why did I only develop the episodes of extreme agitation after several months of being on 1.2mg? Why did I not develop the episodes a few days/weeks after being on the 1.2mg dose? Can you explain that?
Brief Answer:
Divalproex sodium shoukd be a good option.
Detailed Answer:
Hello
Thanks for sharing the details.
Considering the facts, divalproex in a good dose of 500mg to 1000mg is very effective and would start acting in 24 to 48 hours.
Further taking propranolol 40mg every day will also help in combination.
It may not be cause of the medicines and should be a primary psychopathology.
You shoukd discuss with your doctor and get these medicines started.
Another options that can be considered are carbazepine, lithium.
Kind regards
Dr Srikanth Reddy
Divalproex sodium shoukd be a good option.
Detailed Answer:
Hello
Thanks for sharing the details.
Considering the facts, divalproex in a good dose of 500mg to 1000mg is very effective and would start acting in 24 to 48 hours.
Further taking propranolol 40mg every day will also help in combination.
It may not be cause of the medicines and should be a primary psychopathology.
You shoukd discuss with your doctor and get these medicines started.
Another options that can be considered are carbazepine, lithium.
Kind regards
Dr Srikanth Reddy
Above answer was peer-reviewed by :
Dr. Prasad
I have tried epilim - is that the same thing as divalproex? Is divalproex a lot more effective than epilim in treating agitation?
If epilim and divalporex are the same and assuming I have already tried the equivalent dose of divalproex, I would not want to try divalproex because it would be like trying the same thing again.
I am already taking 2 x 80mg sustained release propranolol daily.
What do you mean by "primary psychopathology"?
Would carbamazepine and lithium both work immediately or would they take time to build up in system and if so how long?
If epilim and divalporex are the same and assuming I have already tried the equivalent dose of divalproex, I would not want to try divalproex because it would be like trying the same thing again.
I am already taking 2 x 80mg sustained release propranolol daily.
What do you mean by "primary psychopathology"?
Would carbamazepine and lithium both work immediately or would they take time to build up in system and if so how long?
Brief Answer:
They are related
Detailed Answer:
Hello
Epilim and divalproex are related to each other but divalproex has been mentioning to have a specific role in anger control.
Regarding other options carbamazepine and lithium, they are also good but yes they take time.
You may also try some mindfulness, yoga and other forms of relaxation therapies.
Hope this helps.
Regards
Dr Srikanth Reddy
They are related
Detailed Answer:
Hello
Epilim and divalproex are related to each other but divalproex has been mentioning to have a specific role in anger control.
Regarding other options carbamazepine and lithium, they are also good but yes they take time.
You may also try some mindfulness, yoga and other forms of relaxation therapies.
Hope this helps.
Regards
Dr Srikanth Reddy
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you for your reply.
Isn't epilim simply the long release form of divalproex?
And I am trying to control episodes of extreme agitation - not anger. Why do you mention anger?
And you didn't explain what you meant when you said "primary psychopathology" in an earlier answer - please explain what you meant by that.
Isn't epilim simply the long release form of divalproex?
And I am trying to control episodes of extreme agitation - not anger. Why do you mention anger?
And you didn't explain what you meant when you said "primary psychopathology" in an earlier answer - please explain what you meant by that.
Brief Answer:
Anger and agitation stem from. The same part of the brain.
Detailed Answer:
Hello
Anger and agitation stem from the same part of the brain.
Primary psycholopayhology is a psychological. Phenomenon of agitation arising primarily by itself and not secondary to any drugs or infection or anything if that kind.
Regards
Anger and agitation stem from. The same part of the brain.
Detailed Answer:
Hello
Anger and agitation stem from the same part of the brain.
Primary psycholopayhology is a psychological. Phenomenon of agitation arising primarily by itself and not secondary to any drugs or infection or anything if that kind.
Regards
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
No its different
Detailed Answer:
Hello
No its different.
Kind regards
Dr. Srikanth Reddy MD
No its different
Detailed Answer:
Hello
No its different.
Kind regards
Dr. Srikanth Reddy MD
Above answer was peer-reviewed by :
Dr. Remy Koshy
Thank you for you reply.
Can you explain how it is different and how it would be substantially more effective than epilim in controlling episodes of extreme agitation?
And regarding other options carbamazepine and lithium, how long does each take to build up in your system to an effective level and what dose of each would I take to control episodes of extreme agitation?
Can you explain how it is different and how it would be substantially more effective than epilim in controlling episodes of extreme agitation?
And regarding other options carbamazepine and lithium, how long does each take to build up in your system to an effective level and what dose of each would I take to control episodes of extreme agitation?
Brief Answer:
Divalproex is a different molecule
Detailed Answer:
Hello
Divalproex is a different molecule and it's not that it's better than other molecules that you have taken. But in many cases where one molecule is not effective then it woukd be worthwhile to look for other options as many times the second options are effective and switching medicine does help.
I would suggest you should try divalproex.
Other molecules like lithium and all, take around 4weeks time to get good response.
Hope this helps
Regards
Dr. Srikanth Reddy
Divalproex is a different molecule
Detailed Answer:
Hello
Divalproex is a different molecule and it's not that it's better than other molecules that you have taken. But in many cases where one molecule is not effective then it woukd be worthwhile to look for other options as many times the second options are effective and switching medicine does help.
I would suggest you should try divalproex.
Other molecules like lithium and all, take around 4weeks time to get good response.
Hope this helps
Regards
Dr. Srikanth Reddy
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Kampana
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