Yes Ian. An ssri's. Zoloft the 1st time. Pristiq the second and final time. It caused my anxiety to go through the roof. Uncontrollable. Thoughts on better alternatives to an ssri's?
One of the tricyclic antidepressants (TCAs) with strong norepinephrine, aka noradrenaline, reuptake activity such as imipramine (Tofranil), desipramine (Norpramin) and amitriptyline (Elavil). They have a similar mode of action as Remeron, but have a higher dose range and are much, much less likely to stop working.
Start on a low dose, many TCAs come in 10mg starter tablets which is a tiny amount compared to the typical 75mg minimum therapeutic dose. Increase by no more than 10-25mg every 7-10 days until you get to the target dose. Done this way you should experience little if any startup anxiety. The drawback is that the TCAs have more ongoing side-effects, mostly dry mouth and constipation, but these can be managed and tend to lessen over time.
Given you could apparently tolerate Remeron's sedation, trazodone (Desyrel) is another possibility. It works in much the same way as the TCAs, but has fewer ongoing side-effects (small adjuvant doses are sometimes used to counter both SSRI and TCA side-effects). Its main drawback is that it is at least as sedating as Remeron though this diminishes at the higher antidepressant doses, especially if you take a slow-release formulation. Another potential drawback is that, unlike most other antidepressants, it enhances the libido. Also be aware that it only becomes an antidepressant at doses above 150-225mg/day. Below that it is only a powerful antihistamine, as are most TCAs and some SSRIs. It is the effect on histamine receptors which produces the sedation.