So a few weeks ago I discontinued taking Remeron; I had been on it for about 4 months and was up to 45 mg, then went down to 30, 15, then nothing. The good thing is that I barely have had any adverse discontinuation symptoms. The only ones I believe could be attributable to the Remeron have been a slight uptick in nausea (mainly subtle, mild waves of it that come & go fairly quickly) and some difficulty staying asleep. What I mean by this is that I will fall asleep at my normal bedtime, but then wake up an hour or two earlier than I need to, and I cannot seem to get back to sleep once this happens. This has been, however, improving over the past few days, so that I am now waking up closer to when I need to.
Now that I have been off of the Remeron, I am looking to replace it with another anti-anxiety medication. While I am doing overall fairly well with my daily regimen of Klonopin and Guanfacine, I am not where I would like to be. I still have some annoying hypochondria and obsessions that were less present when I was on the Remeron. During my last pdoc visit, he prescribed me Viibryd, but I have yet to start taking it. The reason for this is that I have had a mostly turbulent history with SSRI's, and I am not keen on having to likely experience the initial side effects of it, which could very possibly include increased anxiety. During this previous visit however, I had discussed with him about the option of gabapentin, and he seemed open to it, but at the time I couldn't make up my mind so I decided to go with Viibryd. Later that evening I decided that I would have preferred to go on the Gabapentin, because it's not an SSRI and it does seem to work quite well for some people, as my psychiatrist had attested himself.
So, I am currently researching whether I should talk with my pdoc about Gabapentin at my upcoming visit next week, or alternatively if I should go on Vistaril/Atarax. Both of these drugs appeal to me because a.) I have never tried any medications in their class before, and b.) they seem to be safe and well tolerated by most people for anxiety.
What I like about the Hydroxyzine is that it can be taken when needed, is fairly effective at mitigating acute anxiety (less so than a benzo, but I have plenty of those on hand), and doesn't produce any withdrawal or dependence unlike the benzos. The main negative side effect I have been reading about is that it can be heavily sedating, and probably will be when (and if) I first start taking it.
Gabapentin, while I know it's not a first-line or second-line anxiety treatment, works for different people, and for some it really is an excellent anti-anxiety medication. Furthermore, from what I understand, it can mildly potentiate benzodiazepines, so in my case it could help to augment my Klonopin. The downsides to Gabapentin that I'm aware of, are that it can cause cognitive impairment, and that it may in some people cause withdrawal reactions. But almost every medication causes a withdrawal of some sort, so that's not unexpected.
What I'm asking about is if any of you have had experience with these two drugs, and/or what your opinions are of them for treating anxiety. I suppose I have to be the ultimate judge by trying either of them, but I am just curious about them and would like to learn as much as I can before making a decision on which one to try.