Thursday, January 03, 2008

Prozac and Tardive Dyskinesia

I am intensely worried. Remember I was telling you about my teeth clicking and the relentless snippets of music running through my head? Well my problems in this area are getting worse, not better, despite taking clonidine to try to help the teeth clicking problem.

My teeth "clicking has turned into a "chewing" like motion. This triggered a worry in me that I may be exhibiting symptoms of Tardive Dyskinesia. Yesterday I went to Pubmed and WebMD and searched to see if it was possible to get TD from Prozac. It appears that both patients and Drs have experienced Prozac leading to this side effect.

I began researching more and found I am having numerous symptoms. Obviously, I am not a pdoc, so I cannot say I have or do not have TD symptoms, because, while I can read what they are, I do not have the knowledge to determine I the physical changes I am experiencing are TD...but I feel I am exhibiting enough of what I have read to be really scared.

Here are the psychological and physical changes I have experienced since starting Prozac:
  1. My mood has lifted. It's not great, but it is way better than what it was. Sometimes I even feel good. This is a huge shift for me.
  2. My mouth is moving in a "chewing" motion, or a "grinding" motion. At times my teeth are tapping to the music in my head. (more about the music later). My jaw feel clenched while this is going on. It is semi-unconscious". Meaning I can stop it for a while if I really focus on stopping it, but as soon as I stop focusing on stopping it the movements begin again. I thought it was happening constantly, but it seems there are times when it stops, starts on its own. I'm not sure if it stops when I'm sleeping. I think so, because when I wake up my immediate thought is..."thank god it's stopped, but then it begins again. If I take Valium at night, it slows down, or stops altogether.
  3. My toes are moving up and down, sometimes my feet "squirm" (move up and down, twist upwards) along with the tapping. This is not continuous...not sure what triggers it...maybe anxiety. They are doing it right now. This type of tapping has happened before in my therapy sessions when I get really stressed out. However, it is happening much more often since I began Prozac.
  4. My fingers tap...this is similar to the toes, and often happens at the same time as the toes. It appears to be doing it to the music in my head, and is very, very fast...sometimes outside music is playing, but it is not in rhythm with that.
  5. This one is weird...I am periodically making a weird, unconscious sound sometimes. It is hard to describe...the best I can describe it is air passing through my voice box, making almost a moaning sound. This is embarrassing as it comes when I'm not expecting a sound. I feel embarrassed that others might hear it.
  6. I have obsessive snippets of anywhere from 2-6 bars of music playing over and over rapidly in my head. These are not aural hallucinations. They are thoughts of the when you get a song stuck in your head. Early on it was 4-5 bars of a portion of the same Schumann piano piece playing maniacally through my head...for days. Now I seem to be picking up music from what I am listening to, or advertising jingles, but it is NEVER the whole piece of music, but an annoyingly tiny portion of it over and over and over and over...(you get the picture).
  7. I am having increasingly anxious and obsessive thoughts. By "obsessive" I mean I am not bringing them into my head. They are appearing like a constant negative feedback loop, rapidly firing bad thoughts at me. The strange thing is, while they, along with the music and my teeth/mouth problems are making me exceedingly anxious, I am not feeling the sadness, sorrow, or depression that usually accompanies them.
  • An example of the above I have been having suicidal thoughts, over and over and over, yet my mood feels okay. The thoughts are about how I could o/d on all my hoarded medications and my dogs heart medications. Usually I cry, or feel sad while having these thoughts. Now I feel anxious because the thoughts won't stop, but nothing in me feels sad about them. In fact, they seem pretty reasonable.
  • Another example is my having negative thoughts about myself. Bad thoughts over and over about how I'm crazy, I am becoming increasingly bizarre, I'm a bad person, I will never get well, there is something deeply disturbing about the person I have become, & (suspicious thoughts) my pdoc is not telling me everything, he is keeping something from me, he's not telling me the truth about my diagnosis etc. Again, the thoughts are causing severe anxiety, my heart rate is up to 78-80 while I'm having them (it's usually 60) and they are coming at me at a rapid rate, but I don't feel depressed, or sad, just really angry, irritable and really anxious.

My pdoc has told me he believes the teeth "tapping" is a Prozac induced "tic". The music he says is an OCD symptom (I have many of those anyways). I called him yesterday because when I went to Pubmed and Webmd, and began looking at TD symptoms, to me, the untrained "experiencee", it seemed I had a few of them. I recognize the difference between my untrained understanding of a description of an illness (TD) and the trained understanding/knowledge of a psychiatrist. I really KNOW nothing about TD and how it presents, and I should trust my pdoc does, but I still cannot help being frightened by what I am experiencing.

I phoned my pdoc yesterday to ask if I can stop taking Prozac. When I called I was anxious to the point of feeling distraught. I explained my fears. He said: "I have never expressed or thought of your Prozac side effects as TD". I asked him if he thought my fears were unreasonable, explaining the Prozac makes me feel better, but I am afraid I will have a permanent physical problem(TD). He said no I was not being unreasonable, especially if the symptoms were getting worse and not subsiding at all.

Some part of me wanted him to categorically claim that my symptoms were definately not TD and to keep taking the Prozac until I saw him again next week. I think when I phoned I was looking for reassurance that it was safe to keep taking it, that my fears were unfounded, not support to quit taking it. I really don't WANT to stop taking it as at least, for the first time in years, my mood has lifted. What if I never find something else that helps?


Rach said...

If there's anything I've learned, it's better to double check on the side effects then suffer them unnecessarily.
I generally take internet websites with a grain of salt - if anything, I give my pharmacist a call, who can give me the lowdown.

Aqua said...

Hi Rach,
I am usually pretty cautious about info I find on the internet. I am generally suspicious of internet info, but pubmed is a site my pdoc gave me. It is full of abstracts of peer reviewed studies and is quite helpful, but like I said in my post...I'm untrained in medical things and it could be that the OCD nature of my thinking is pushing me to worry excessively.

jcat said...

Ok...some good news first of all. The basic definition of TD is extrapyramidal symptoms (EPS) which include all kinds of twitches and tics, but that - key words here - start well after taking the meds, and sometimes even after discontinuation. Prozac and EPS? Yes, although rare. Prozac and TD? Absolutely nothing off any vaguely reputable sites.

So while Prozac is possibly causing the EPS, it's pretty much guaranteed that those would disappear once it cleared your system (bearing in mind the 5 week half-life). Nothing permanent. And quite a few of the references do mention transient EPS that wears off after a while. Prozac gave me the "shaky hands", which lasted until I stopped it.

In the meantime though....bloody irritating. I am more worried about the suicidal thoughts and that they don't make you sad.

Aqua said...

Hi Jcat,
Thanks for the info. There are references to TD and Prozac on various reputable websites. "tardive" means late onset...usually referring to side effects beginning after being on the medication for a long period of time, but some of the studies are saying with prozac the onset is very quick...a week to four weeks after strating it. If you go to Pubmed (US National Library of Medicine) and type, "Prozac, Tardive Dyskinesia" in the search field you will find abstracts describing just this. You are right though, in many of the articles suggested that the symptoms will go away after stopping them...but one I read the lady still had symptoms 6 mos. after stopping prozac. Another said TD continued at least a year after the medication was stopped.

About the know what...I don't care anymore. This life is just too confusing and I feel I will never know wellness again. Even when I feel better other crap ruins my experience of life. I'm hanging on right now for my dog, but he's sick and when he goes I don't see much holding me here. Sorry to be so bleak, but that's how I feel.

jcat said...

Sorry... didn't mean to dispute what you've read. Although, a lot of what Pubmed indexes is references that aren't necessarily studies, but include letters to editors, proposed studies etc.

No doubt that Prozac and other SSRIs are implicated though in movement disorders. Many of the cases include other drugs that are known to cause issues, but even on its own there are a few.

The main thing though is that almost all of them resolve on either dose reduction, discontinuation or spontaneously, whereas TD tends to persist way after.

So main point was that it's quite likely Prozac causing the tics, it's also more than likely that they will resolve, and that stopping it before you see pdoc this week probably isn't called for. Especially with some lift in mood from it.

Will mail you re other bits.

Polar Bear said...

I hope it's not TD. TD is something I fear for myself, as I am taking an antipsychotic and they are known to cause TD.

I hope the symptoms subside for you. I can understand this is freaking you out.

Anonymous said...

I found your comments by searching "music in your head with Prozac". I noticed after taking Prozac 10 mg. for awhile, redundant music playing in my head became bothersome, even waking me up at night. I found out that if I take the medicine every other day, the music tones down. My doc seems okay with this. Hope this helps.

Anonymous said...

Within 3 days of starting Prozac,I developed both psychosis and TD. Both are bad. Arrest a psychiatrist.