A friend is in the following situation and needs urgent. This is not me BTW-not that there would be any shame if it were- and really is the situation of a friend:
He experienced a number of consecutive traumatic events -divorce, followed by a number of deaths of closed ones in rapid succession- and cried non-stop for a week. He is a sensitive individual by nature and arguably had an excessive reaction to the events. Of course, what matters is the subjective experience, as opposed to the specific sets of external circumstances.
This was all ~ 1 year ago
He was prescribed an SSRI (Cipralex) and had an excess reaction to it. It appears that he has experienced SSRI toxicity, though in retrospect some doctors disagree that this is what has happened. The reaction was excessive however. He fainted due to very low blood pressure and the hot flashes and fevers were so excessive that he had to go to the ER and was given an ice bath. This happened twice and completely traumatized him.
To make matters worse, he tapered off the medication under doctor supervision and felt perfectly fine for around 2 months. Then, suddenly he had a cluster of symptoms come in which again sent him to the ER. The symptoms included:
Flushing / hot flashes, feeling terribly hot
Unbearable headaches
Elevated heart rate that would not come down no matter what
Racing mind and extreme fear/anxiety.
Again, just to reiterate, this is all happening while he is no longer on the medication; it had been 2 months since he took the last dose.
He then gets no sleep for almost 3 full days, is taken to the ER and it turns into a traumatic event of epic proportions once again.
After this episode he was put on SSRIs again, this time Lustral (because it was thought that it was the removal of the SSRIs from the treatment that resulted in the aforementioned crisis)
Now fast forward to today, when he has taken the Lustral dosage down slowly all the way from 100 mg to 25 mg. He is still experiencing the below symptoms:
- Hot flashes and feeling really warm (usually in the morning -sometimes starting as early as 5 AM, which wakes him up)
- Headaches, especially when he gets out into the sun
However, the real important issue is the OBSESSION AND FEAR that he has developed as a result of all this. He has absolutely pathological obsession and all he thinks about is when / if he will once again suffer the multi-day attack that I described above. He fears of losing his sanity and ending up in a mental institution if that should occur again. All he constantly thinks of and asks those around him are the following:
- Will I ever heal?
- Have the SSRIs done permanent damage?
- Is the damage on par with that suffered by recreational drug addicts?
- The very low dose (25 mg) Lustral I am on is giving me morning flushes, making me anxious and makes me suffer from headaches. I want to come off, but if I so will the same multi-day attack occur again?
and so on, so forth...
It is very obvious to everyone around him that he has crippling obsession; impossible to operate and carry on a semi-normal life under these circumstances and he is likely to be fired from his job too if it goes on like this. He spends all day on the internet browsing about this topic and his boss prohibited him from going online unless absolutely required for his day job. Really this obsession is 24/7 and he cannot go on like this.
We can argue, as some doctors did, that what he has previously suffered was not SSRI toxicity; especially considering that he had severe symptoms 2 months after quitting the SSRI. Fair point, though we currently have to battle the crippling obsession.
He is beyond the point where talk therapy can be of use (or can be of use quickly enough to save the situation) and I believe that he needs medications. Here is a list of meds that can be of use here (IMHO):
https://www.drugs.co...e-disorder.html
Now there are several classes of drugs in the list above, including SSRIs. Those are out of the question given the extreme reaction he has exhibited to SSRIs in the past.
Also benzodiazepines should be ruled out due to the constant nature of the problem. He would need to take benzos continuously (not like the worry and obsession comes occasionally; it is ever present) and the constant benzo use would carry too high an addiction risk.
However, this still leaves us with a lot of alternatives, including
Tricyclic and tetracyclic antidepressants
5HT3 receptor antagonists
Typical and atypical antipsychotics,
