Posted by Tony P on February 7, 2008, at 16:05:48
In reply to Re: ssri's and anxiety, posted by Maxime on February 7, 2008, at 14:39:46
> Hi John
>
> Anxiety is awful. SSRIs can help, but in your case it doesn't look like it. Most people get tired on Luvox.
>
> Seroquel might be good for your anxiety.The tricyclic anti depressant Clomipramine use to be the gold-standard for OCD before the SSRIs came along. Maybe that would help.
>
> If you want to try another SSRI go for Lexapro as it is sedating and used for anxiety.
>
> Best of luck to you.
>
> MaximeI too sympathize. I can't take most SSRI's as I get anxiety-related side-effects plus a fairly predicatble anxiety attack with OCD components about noon or mid afternoon -- just when I need to be most productive.
I agree that Lexapro (Cipralex/Escitaprolam) is the best bet for low side effects. I tried Paxil (sweats and shakes), Effexor (supposed to be good for social anxiety!) and was crazy-anxious after a month or so on a fairly low dose, and Celexa gave me extreme anxiety to the point of an out-of-body experience!
I was reluctant to try Lexapro after my experience with Celexa (which is like impure Lexapro, forgive me for oversimplifying). However my pdoc persuaded me that the isomer of Celexa left out in Lexapro was responsible for 90% of the side-effects and 10% of the anti-depressant effect. Turned out it wasn't just manufactuirer's hype, he was right. I was OK on Lexapro at 10 mg/day, essentially zero side effects, but at 20mg/day I started having these anxiety/agoraphobia/OCD attacks around mid-day again. Clonazepam helped a lot but my tolerance is very high so I was having to take 4-6 mg/day, which most Drs don't like prescribing long-term.
BTW, I'm currently taking Remeron 30 mg/day, Requip (ropinirole), a DA agonist which seems to be a good AD adjuvant, Clonazepam 2 mg/day and recently selegeline (oral not EMSAM) 10 mg/day. The latter plus a cup of espresso gives me good mood-brightening and energy, but the daytime anxiety is back!
I'm beginning to think the mid-day anxiety attacks are part of my natural daily cycle and have a huge behavioural component (I obsess about feeling anxious, don't want to leave my apartment, so I feel guilty about not doing chores or missing appointments, so my anxiety goes up even further until I "freeze", get into compulsive reading or computer game-playing and (sometimes literally) pull the bedclothes up over my head!I'll be seeing a new pdoc next month and I would be willing to give Lexapro another try, but not any of the other SSRI's or SNRI's without a lot of persuasion and/or a good supply of a benzodiazepine to fall back on. The Clomipramine is a good suggestion, too, I was just looking at that on the web a few nights ago, it looked helpful enough that I was tempted to try it on my own while I wait for the pdoc appointment, but I'm already messing around with my own medication too much for safety, so I'll wait for his opinion.
Meanwhile, I'm also seeing a cognitive-emotive counselor whom I've know for many years, and I want to work with him on behavioural ways to cope with what's now clearly a very general pattern for me regardless of what meds I'm on.
Good luck and let us know how it goes,
Tony
poster:Tony P
thread:811306
URL: http://www.dr-bob.org/babble/20080207/msgs/811324.html