I've been procrastinating meds for months now just because I am affraid to take them .... I have one simple question because my anxiety is becoming horrible..... Which has the least start up anxiety out of these because I wanna take whichever one that is... My psych is open minded to all options so I wanna know which Will have the least start up anxiety side effects ....
You should take the route of TCAs(Tricyclic)
or MAOIs (Monoamine Oxidase Inhibitor)
later, if the SSRIs (Selective Serotonin Reuptake Inhibitor)/SNRI's (Serotonoin Norepinephrine Reuptake Inhibitor)
don't work out for you. My reason for this is that MAOIs
(which are the oldest class of antidepressants on the market) have a lot of diet restrictions. Also, if you continue to visit this forum, no one on this forum takes a MAOI,
so you wouldn't be able to use this Medication forum for support from an actual user of a MAOI.
Likewise few doctors regularly prescribe MAOIs
- at least in the United States, although this maybe different in outside countries - so you should stick to medications that a common doctor, or preferably a psychiatrist, is familiar with distributing. It's like getting a good mechanic, however if that mechanic has never worked on Volkswagen's, he could possibly screw up, since he doesn't know their engines very well, so you should stick to what the person is familiar with. And as I mentioned earlier, there are a lot of diet restrictions with MAOIs.
If you prefer to eat out, you'll annoy your friends/family with your constant need to check out restaurants, prior to visiting them, so the restaurants can accommodate what you can eat. If they serve food - not within your allowed diet - you may feel like the downer of the party that you can't go to that restaurant. Also you'll have to make most of your meals yourself, just to be aware you don't ingest anything contrary to the medication. So these dietary issues could be annoying for many people.TCAs
are an option, however again, you should turn to them, if you just can't take the SSRIs.
The reason why is that the TCAs
will more than likely have more side effects for you, as a new antidepressant user. There are a few regular posters who take TCAs
on this forum, one of them being Ian, and there are two others I'm aware of, who are newbies on the medication (meaning they just started within the past year). You would probably relate to them more. However there are many users on this forum who take SSRIs,
so there will be a lot more data you can use on this forum, if you do searches on a SSRI
, than a TCA.
there will be issues with water consumption, since you'll have a dry mouth. If you exercise regularly, or play a competitive sport, this will be a hassle, since you're going to need water breaks, as well as restroom breaks, regularly. Your may feel self conscious for having to excuse your self regularly from your team. Also sweating in high temperatures have been a known symptom with TCAs.
In addition, TCAs
are usually distributed in smaller quantities per day in comparison to SSRIs.
For example, if you take 100mg of Impramine (Tonafranil)
which has been labeled 'the gold standard for anxiety' on this forum, you would probably break the dosage into three. You would take 2(25mg) in the morning, one 25mg for lunch, and the last 25 for dinner.
However I take Zoloft (Setraline)
, a SSRI
, and I take my medication just once a day in the morning. For me, I find this convenient, since I don't have to remember taking it later in the day. If I go out in the evening, I don't have to remember taking my medicine and having to bring it with me. So for me, taking a medication once a day is better than taking it two to three times a day. Hence, TCAs
may be more of a hassle, if you have to take them regularly two/three times a day, instead of once.
So this leads me to the SSRIs.
I believe you've been on Zoloft (Setraline)
at 20mg, and that did not work too well. I believe you stated that the dosage almost made you feel insane. Zoloft, Effexor
are the most stimulating SSRIs,
so it seems these higher stimulating SSRIs
won't be a match for you. The more neautral SSRIs are either Escitalopram (Lexapro)
and Celexa (Citalopram)
which are actually very similar, however a more sedating antidepressant is Paxil (Paroxetine).
Since you seem to have gotten hyper on a low dose of Zoloft (Setraline)
, I would recommend you go on a sedating SSRI, such as Paxil.
And if Paxil
doesn't work out, you can then try either the Lexapro
The reason I didn't mention the SNRIs
is because Effexor (Velafaxine)
maybe too stimulating for you, since you couldn't tolerate Zoloft (Seteraline)
, and I believe you've already been on Cymbalta (Duloxetine),
and that med hasn't worked out. The other SNRI, Pristiq (Desvenlafaxine)
is expensive, without a generic, and many posters on this medication have complained about its price. Since most doctors have you on an antidepressant for at least a year, Pristiq
would get very expensive after a few months.l
So after some time to think these meds over, I think you should take the Paxil
route. I recommend Paxil,
based on what you've written as your symptoms on this forum, and you seem akin to a sedating antidepressant, which Paxil
fits. You should also look to other posters on Anxiety Zone for familiarity with how they handled their antidepressant transition on Paxil.
I recommend you look at BrendaB123's thread on her start-up on Paxil.
She started around early December, and things worked out well, where she's now comfortable on the medication, and doesn't feel a strong need to come to the Medication Forum for support. I believe she hasn't posted since the beginning of January, so she seems fine.
Please check out her thread:http://www.anxietyzone.com/index.php/topic,79366.15.html
Likewise, BrendaB was also on a benzodiazepine
regularly, which greatly reduced her anxiety, so the transition was rather smooth for her. You should really discuss with your doctor about following Brenda's route in being on a benzodiazepine regularly, until your body adjusts to the antidepressant. Brenda actually started on Valium (Diazepam)
for a month. In fact she was having panic attacks prior to the Valium intake, but after a month on Valium, she was calm and collective again, and so her doctor then redirected her to a psychiatrist, who next transitioned BrendaB onto Paxil.
While on Paxil,
she still used a benzodiazepine,
but she stuck to the Klonopin (Clonazepam).
And as you know, after a three/four weeks, she's back to her life, and doesn't feel a need to come to this forum for support, which is a good thing!
So Paxil (Paroxetine)
is my recommendation. You should also discuss your options with your doctor.