How to manage severe anxiety and agitation effectively?

Hello doctor,

I have been struggling with severe anxiety and restlessness for the past seven months. I began taking Prozac a few months ago but had to stop due to strong side effects. I then tried Buspar for five weeks before going back on Prozac a month ago. I started at 5 mg for a week, increased to 10 mg for two weeks, then 12.5 mg for a few days, and finally 15 mg for four days. Unfortunately, I have not experienced any improvement yet. In fact, over the past two weeks, alongside the restlessness that prevents me from staying still or resting, I have become increasingly agitated to the point of feeling beside myself, with urges to scream or break something. This heightened state of anxiety and agitation has made it impossible for me to relax or even lie down comfortably.

My insomnia has worsened due to the anxiety, and despite taking 7.5 mg of Mirtazapine at bedtime, it is no longer effective. I often have to resort to Trazodone or Lunesta, but even with these, I only manage to sleep for a few hours, and sometimes, they do not work at all because of the high anxiety levels. My doctor has suggested that the worsening of my symptoms could be a result of the Prozac, and she recommended discontinuing it. However, the thought of stopping Prozac before knowing if it could eventually help, coupled with the fear that my symptoms might worsen if I continue, has caused panic and agitation. I am unsure whether Prozac could cause such severe agitation at low doses and whether it is possible not to experience any improvement after a month on low doses like mine. Is it possible that higher doses, such as 20 mg, could suddenly bring about improvement? Currently, I am in a very bad state, with constant anxiety and agitation. I do not have anything to calm me down, as I have been off benzodiazepines for two months now. While my doctor suggested Seroquel, it only made me feel numb and unresponsive without calming me down.

I am unsure about going back on benzodiazepines, but I do not know how to cope with my current state without them or without finding an alternative solution. Do you have any suggestions for something that could help me calm down while I either continue with Prozac or explore other treatment options? Kindly guide.

Thank you.

Hi doctor,

Thank you for your reply.

I have been dealing with anxiety for eight months. I was on low doses of benzodiazepines for five months, not exceeding 1.25 mg a day, taken in divided doses. I gradually tapered off from the benzodiazepines.

Unfortunately, my anxiety has worsened over time and has become extremely intense. I am now experiencing constant restlessness and agitation that leaves me feeling beside myself. My sleep has been severely affected for the past four months, with difficulty sleeping for more than five or six hours at most. Often, I only manage to sleep for two, three, or four hours, and when I am awake, I struggle with unbearable anxiety that prevents me from falling back asleep. The cycle of sleep deprivation and anxiety has left me feeling weakened and panicked. Medications like 7.5 mg of Mirtazapine, which used to help me sleep, now only provide temporary relief for about an hour and a half before I wake up with intense anxiety around midnight. I often have to resort to taking either 50 mg of Trazodone or a Lunesta sleeping pill, but they are not very effective when my anxiety is severe.

I have lost my appetite and have lost 8 pounds, weighing only 103 pounds now. My head feels under intense pressure, and my body feels extremely tight and achy from lack of exercise due to exhaustion. I am struggling to make it through each day and night, feeling constantly weak and stressed due to anxiety and lack of sleep. I had hoped that Prozac would help, but I am distressed about having to discontinue it before seeing if a higher dose would be beneficial. However, if it is causing the agitation, I understand the need to try something else.

In the meantime, I am desperate for relief and wondering if there is anything I could take during the day to help calm me down. My doctor plans to start me on Cymbalta soon, but any suggestions for immediate relief would be greatly appreciated.

Thank you.