Why would my doctor would prescribe an SNRI over an SSRI for GAD?

[anxiousashley]

I  began my battle with anxiety about 4 months ago after seeing my twin sister get hit by a car. I didn't have a primary care physician, but after several visits to the hospital, I decided to finally get one. My mom reccomeneded a doctor that my aunt sees. So I went to her and explained my symptoms. I told her that I was having anxiety, insomnia, high blood pressure, physical pains all over my body, twitching, chest pain, shaking, etc. I also let her know that I had went to the ER twice for my symptoms, and that they couldn't find anything but anxiety. She listened to my heart and lungs, which she said sounded fine. She did an ekg, which the only thing she noticed was a rapid heartbeat, which she said was due to anxiety. My bp was 140/90, but she said that was likely to be anxiety related as well. After my first visit was her was done, she gave me some samples of 30mg Cymbalta. I did not know what Cymbalta was, but when I went home I read about it. I decided to just try it, because I was having such severe anxiety.

Well, I was one of those people who get severe side affects from Cymbalta. The first night on it I jerked out of my sleep, and my insomnia got worse. A next morning, I ended up in the ER again. My chest pain had gotten severe. i experienced my first panic attack and heart palpitations. It was the scariest feeling in the world. The next night I immediately stopped the medication. However, for three weeks after that I was in constant pain and having full blown anxiety. I couldn't breathe when I went outside. The ground would move beneath me. I would feel lightheaded, dizzy, and like I was going to pass out. I also begain having difficulty breathing. Before I took the Cymbalta my anxiety and pain wasn't constant, but after it was there 24/7.

So after suffering for those three weeks after discontinouing the Cymbalta, I decided to go back to my doctor. I told her about my side effects from the Cymbalta and that I had stopped. She told me that I needed to stick with the medication as it would help. I was so desperate and so ready to give up, that I decided to give it another chance. I again had the intense side effects. However, after a few weeks most of them went away. My mental anxiety symptoms like the lightheadedness and vertigo dissapeared. At the same time, though, my physical pain especially my chest pain were still constant. So I during my follow up with my doctor, she decided to raise my dose to 50mg. Once upping my dose, I experience the bad side effects again, though not as worse. However, I stuck it out. I'm now in my second week of the upped dose.

I'm seeing some improvement, but I'm having thoughts as to why my doctor even prescribed Cymblata instead of an SSRI. Is this medication more effective. Should I still be on it even though I had really bad initial side effects? Another thing that bothers me, is that the medication has helped with anxiety, but now I'm depressed. I have sucidial thoughts, where I didn't have any before. Does this all seem like it is stemming from the medication. Is Cymbalta a good medication for GAD?

Thanks to anyone that can help! =)

[gcalex]

All meds affect people differently.  Both classes of meds you mention are used for GAD quite frequently.  Sometimes it is a trial and error process.  As to your description, suicidal thoughts are extremely concerning -- please contact your doctor ASAP.  This can be a rare but serious side effect of antidepressants, and one that (in my opinion anyhow) requires you to let your doctor know.

[sixpack]

i agree with gcalex on the suicidal issue.  For some reason suicidal thinking can be an effect of AD's.  An effect that needs to reported to the doc.

Hang in there, things get better.

[anxiousashley]

but what about besides the suicidial thoughts? would any of the other stuff be concerning?

[gcalex]

Side effects such as increased agitation are not uncommon with starting these types of meds and dose changes, and it sounds like you had a host of symptoms before you started on the med to begin with, so if the symptoms that troubled you went away eventually, I would not be terribly concerned.  In other words, the fact that you experienced side effects (leaving aside the suicidal thoughts) does not mean you were prescribed the wrong medication.  If you still have chest pain obviously you should check that out, but that wasn't clear from your post. 

[sohelpless]

The initial side effects are usually bad but subside over time.  It's when they don't subside, then it's concerning.  As far as the depression and suicidal thoughts, those should pass too but if not by a couple of weeks, then it may not be the right med for you.

I don't think there is any reason why a doctor would choose an SSRI over an SNRI.  It's all hit or miss with antidepressants.  Maybe in their practice, they've seen more success with it.  But all the meds work similarly. 

[gcalex]

Again, if you are having suicidal thoughts after two weeks of an increased dose, I would urge you to be on the safe side and contact your physician.  Let them advise you whether it is best to cut back/taper off or to stick it out.