Anxiety/Panic

[Ctenney]

I am prescribed the following for my Crohn's:

Budesonide (Entocort) - 3mg/24HR - take 3 Capsules Once Daily
Ciprofloxacn - 500MG - take 1 tablet twice a day
Pentasa (Mesalamine) - 500MG - Take 4 capsules twice a day.
Tinidazole Tab 500MG - Take 1 tablet twice a day.

I have been on Pentasa forever, so I'm not sure that it is the cause. The others I have been on for about 6 months and since then my anxiety and panic feelings have been much higher. I suppose it could be outside the medication, but I was wondering if anyone had anxiety or panic issues as a side effect for any of these medications / combos. I haven't discussed this issue with my doctor yet. I've had issues with anxiety before, but never this bad.

Best

 

[Patricia56]

Cipro is the most likely culprit followed by budesonide.

Anxiety is a known side effect for Cipro. If you are already vulnerable to something like anxiety then, in my experience, that side effect is much worse than if you weren't already vulnerable in that area. I'd talk to your doc about stopping the cipro.

The budesonide is topical prednisone and up to 20% or so is systemically available depending on the way your body processes the drug. So you can have the same side effects as if you were on oral pred.

Being on budesonide at that dose for that long is not according to the manufacturer's recommendation. This drug should be discontinued after about 3 months. By now you should have gone on Imuran/6-MP/AZA or methotrexate as a maintenance med rather that the budesonide. Assuming your symptoms are under control. If not then you should probably be on a biologic like Remicade or Humira.

 

[Orchid]

Budesonide could cause personality disturbances as a corticosteroid but it's insanely high first pass metabolism means that's a bit sketchy. I could see it if you're built like a rail or have a known mental reaction to prednisone. Ciprofloxacin has also been known to cause CNS problems and personality disturbances in extremely rare cases but I'd find it more likely you have anxiety and panic attacks independent for those medications.

Also, welcome to the Crohn's Forum.

 

[Patricia56]

The other approach (besides stopping CD meds) is to seek treatment for the anxiety, in case you are not already doing that. Cognitive behavioral therapy (CBT) and Dialectical Behavior Therapy (DBT) are both excellent, non-medication treatments that are often effective in treating anxiety/panic.

You could also see a psychiatrist and find out whether medication might be an option to help when the symptoms are severe. The psychiatrist may be more likely than the GI to accept that the CD meds have worsened your anxiety and to be supportive. Unfortunately, in our experience, the GIs we have worked with were universally ignorant and in denial about psychiatric side effects of the meds they were prescribing.

In the meantime I hope you have some basic coping skills to help you manage - deep breathing, relaxation exercises, mindfulness. Having a talk therapist can also be very helpful and they can do CBT with you.

 

[Ctenney]

The other approach (besides stopping CD meds) is to seek treatment for the anxiety, in case you are not already doing that. Cognitive behavioral therapy (CBT) and Dialectical Behavior Therapy (DBT) are both excellent, non-medication treatments that are often effective in treating anxiety/panic.

You could also see a psychiatrist and find out whether medication might be an option to help when the symptoms are severe. The psychiatrist may be more likely than the GI to accept that the CD meds have worsened your anxiety and to be supportive. Unfortunately, in our experience, the GIs we have worked with were universally ignorant and in denial about psychiatric side effects of the meds they were prescribing.

In the meantime I hope you have some basic coping skills to help you manage - deep breathing, relaxation exercises, mindfulness. Having a talk therapist can also be very helpful and they can do CBT with you.

Thanks Patricia,

I have an appointment with a psychologist this week to pursue therapy. I hope this helps. I'll keep you posted with how things progress. I don't have another appointment with my GI until October. But I'll shoot him an email.

I appreciate all the feedback.

 

[Orchid]

I wish you the best of luck, panic and anxiety are awful enemies.

 

[Ctenney]

I wish you the best of luck, panic and anxiety are awful enemies.

Orchid,

Thank you.

And yes they are! I would have described mine as mild up until recently and then just seemed to explode out of the blue.

 

[Orchid]

Have you considered trying mindfulness/meditation? It helped quite a bit with mine, it takes a while to pay off though.

 

[Ctenney]

Have you considered trying mindfulness/meditation? It helped quite a bit with mine, it takes a while to pay off though.

I have, but I've been terrible about doing it consistently. I need to make an effort to make time for mindful meditation every day.