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Author Topic: Good long-term med (maybe non SSRI) for general anxiety?  (Read 332 times)

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Offline dh1972

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Good long-term med (maybe non SSRI) for general anxiety?
« on: December 30, 2013, 06:53:02 PM »
Hi All,

I'm a 41 yr-old-male who started suffering anxiety and insomnia issues earlier this year.  I had started stressful job and had a family situation that triggered really bad insomnia as well as anxiety.  I had a couple of panic attacks after drinking coffee, back in May.  I also worry about my health because of family heart issues, even though I am healthy, exercise (aerobic and resistance training) and eat very well.

On any rate, my general Dr. sent me to a Sleep Dr. to address the insomnia.  I was on Trazodone for several months at varying dosages.  While that by and large helped my sleep, it actually increases my anxiety (I know, bizarre).  I've been on/off it about 4-5 times since and every time I am on it, my anxiety shoots up - and I was on it when I had those two panic attacks.  The problem is, it does help me sleep at night!

My general Dr. had put me on Zoloft, but that made my insomnia REALLY bad and quit it after 4 nights.  It was awful and made my stomach sick.

I've tried Mirtazapine for just a few days - stopped it because I was so very groggy and really irratitable - and I rarely ever get irratable.  However, I am thinking of resuming it and seeing if those effects will pass after a week or so.

I also tried Doxepin for about 9 night for insomnia.  I felt fine taking it, but would not get me drowsy (from 10-30 mg).

I've tried Buspar for about 9 days (20-30 mg a day) and it seemed to help only very slightly.

My general Dr. has given me Xanax .25 mg of 30 pills for a month at a time.  I have been taking it about 2-3 days per week, one or two pills at night for sleep.  My anxiety also always gets worse at night.

I was seeing a general therapist for cognitive behavior techniques.  My issue has been excessive worrying and dwelling on things that could happen which are bad.

Anyway, my question:  I need something for general anxiety because I know occasional Xanax is not the answer, but at the same time I need something for sleep or at least something that will not hurt my sleep like Zoloft did.

My sleep Dr. once offered me to try another SSRI paired with Trazodone, but not sure that combo would work as Zoloft and Traz didnt.

Is there another trcyclic or SNRI worth trying that might not affect sleep?  Or maybe try another SSRI like Celexa which I hear is more mild?

I will probably try the Mirtazapine once more and that could possibly kill two birds (insomnia and anxiety) with one stone and simplify things for me a bit.

Thanks!

-D
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Offline insights

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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #1 on: December 30, 2013, 07:39:47 PM »
You could try taking trazodone at antidepressants doses. While some start seeing benefits at 150mg, most need to take at least 225mg before it begins to function as an antidepressant.

Taking Doxepin as an antidepressant is another possibility. The minimum dose if then 75mg/day, but most need at least 100mg.

Apart from those two, just about any SSRI, SNRI, or tricyclic may do the trick. The tricyclics are all sedating to some degree.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dh1972

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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #2 on: December 30, 2013, 07:59:51 PM »
Thanks, Ian.

Does Doxepin become more sedating than the 30mg dose I was up to?  I felt nothing on it at all as far as sedation.

When I was up to 150 mg on Traz. I just couldn't deal with the side effects of stuffed up nose at night and lightheadedness...

Also, any heart issues to be concerned about with tricyclics?  My sleep Dr. said that is generally not a concern for most.
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Offline dh1972

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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #3 on: December 30, 2013, 08:08:04 PM »
Also, can Mirtazapine be decent for anxiety?
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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #4 on: December 30, 2013, 10:17:35 PM »
Does Doxepin become more sedating than the 30mg dose I was up to?  I felt nothing on it at all as far as sedation.

Yes.

Quote
Also, any heart issues to be concerned about with tricyclics?  My sleep Dr. said that is generally not a concern for most.

Yes, they affect the electrical system of the heart, however, unless you have heart disease this is unlikely to be an issue, and even then only at the higher doses. I take dosulepin, aka dothiepin, which is the most cardio toxic of them all, so toxic that its use is now restricted in the UK, its main market and it has been removed from the  British National Formulary, the med 'bible' used by British doctors. Despite being on 225mg, which is above the absolute maximum 200mg, I've had no heart issues in the ~18 years I've been on it, including the last 9 when my heart has been under greater strain following the removal of a lung. Both citalopram (Celexa) and escitalopram (Lexapro) may also cause the same heart issue.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dh1972

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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #5 on: December 31, 2013, 01:40:35 PM »
Ian,

For general anxiety are Doxepin and Mirtazapine pretty equal in most cases?
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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #6 on: December 31, 2013, 04:24:27 PM »
For general anxiety are Doxepin and Mirtazapine pretty equal in most cases?

No antidepressant (AD) is intrinsically better than another, either generally or for a particular disorder, though one probably will be for an individual. The problem with mirtazapine is that it is the AD most likely to poop-out, often after only a month or two, plus you've never really had carbohydrate cravings until you've been on mirtazapine. But that said, it might be the perfect med for you.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dh1972

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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #7 on: December 31, 2013, 05:10:09 PM »
When I tried Doxepin, I was only on it for about 9 days because it was being used to get me to sleep.  However, as mentioned, it did not sedate me even at 30 mg.  However, on the plus side I got no side effects on it...I am wondering if I should revisit it with a higher dose? 

I meet with my sleep Dr. next week and he is pretty open to my suggestions as he knows all of these meds are trial and error for the individual.
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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #8 on: December 31, 2013, 07:01:49 PM »
I am wondering if I should revisit it with a higher dose?
Probably not while you're still on Zoloft. Unlike trazodone, doxepin is an antidepressants at all doses, though a slightly weak serotonin reuptake inhibitor.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dh1972

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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #9 on: January 01, 2014, 01:47:48 PM »
I am not on Zoloft.  I only tried Zoloft for 4 days back in the summer, but had to stop because it caused me horrible insomnia and bad nausea.

So, if I am not taking anything else, maybe Doxepin at higher dose for insomnia and anxiety?
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Re: Good long-term med (maybe non SSRI) for general anxiety?
« Reply #10 on: January 01, 2014, 06:39:50 PM »
So, if I am not taking anything else, maybe Doxepin at higher dose for insomnia and anxiety?

Sure, it is as likely to work as any other antidepressant and insomnia shouldn't be a problem. I do suggest you only increase the dose by 25mg every week or so. Tricyclics usually produce fewer and less severe side-effects than the SSRIs initially (but more ongoing ones like dry mouth and constipation), but it still pays to go up slowly at least until you gauge how you react to it.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

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