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Author Topic: SSRIS , TCAS , SNRIS, or MAOIS?  (Read 421 times)

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Offline chris1234

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SSRIS , TCAS , SNRIS, or MAOIS?
« on: January 28, 2014, 01:45:27 PM »
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 ....
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Offline Abraham2007

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #1 on: January 28, 2014, 03:11:31 PM »
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 ....

Hi Chris132.

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.

With TCAs, 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 and Prozac 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 or Celexa.

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!  :laugh3:

So Paxil (Paroxetine) is my recommendation.   You should also discuss your options with your doctor. 

Good luck!

Steve

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Offline insights

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #2 on: January 28, 2014, 04:26:04 PM »
Which has the least start up anxiety  out of these because I wanna take whichever one that is.

Firstly, not everyone has startup side-effects, and for most they are fairly mild. Severe side-effects are the exception rather than the rule. Even when severe they can be moderated by starting on a low dose, ramping it up by the small amount every week or so until you get to the target dose, and having one of the benzodiazepines to help ease you through any rough spots. If your doc is a benzophobe then the antihistamine hydroxyzine is nearly as good. Celexa would be a good first choice as it is the antidepressant most tolerate the best.

To give you the complete answer to your question, the tricyclics usually produce the least initial side-effects, but they have more ongoing ones such as dry-mouth, constipation, sedation, and often a bigger hit on the libido. The MAOIs are also initially fairly benign, but their dietary restrictions can make them a real pain in the butt to live with.

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 chris1234

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #3 on: January 28, 2014, 05:37:36 PM »
Thanks guys the only problem with me starting on a benzo first is that it will definitely slow me down as I play competitive hockey but I guess beggars can't be choosers?
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Offline chris1234

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #4 on: January 28, 2014, 05:41:06 PM »
And yes the Zoloft made me bring myself to the hospital it was the most exrcutiating panic that lasted for 3 days and benzos did NOTHING too touch it until the medicine came out of my system
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Offline Abraham2007

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #5 on: January 28, 2014, 06:11:21 PM »
Thanks guys the only problem with me starting on a benzo first is that it will definitely slow me down as I play competitive hockey but I guess beggars can't be choosers?

You mean, a benzodiazepine would slow you down - as sedate you?  This depends on the benzodiazepine prescribed and the dosage.  Ideally the benzodiazepine should calm you, where you don't feel anxious when you play, and you can then focus on the game, and play better.  Calm hockey players score better goals, compared to anxious hockey players, who have issues with concentration.

From my interaction with Brenda, she at first said that Paxil and Valium sedated her, but Valium by itself was beneficial to calm her and make her more alert at work (and not make her sleepy). Her doctor worked around her sedation with the Valium/Paxil combo, and gave her Klonopin instead, which worked well.  I don't believe reading about issues of sedation (like at work) from her use on Klonopin.  The Klonopin actually made her transition to Paxil easier.   She also stated she had to be alert at her job,  likewise she had a very demanding job in terms of her duties, while she was taking the Klonopin/Paxil combo.

Many people who come to this forum do say a benzodiazepine made all the difference in transitioning on a antidepressant much smoother.   
http://www.anxietyzone.com/index.php/topic,80971.msg456807.html#msg456807

From your own experience, you know transitioning on an antidepressant can put you in a state of anxiety, if not administered properly. Given your last experience on Zoloft, I don't think your doctor did a good job in putting you on an antidepressant properly.  The last benzo may have not taken you out of your 'shock' on Zoloft.

For many, though, if put on an antidepressant properly, a benzo can help decrease the anxiety during the transition on to the antidepressant.

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Offline hikingchik63

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #6 on: January 28, 2014, 06:41:29 PM »
If Im anxious, and take a low dose of a benzo, it does not sedate me, only calms me enough to concentrate on the task at hand, as a "normal" person would.
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"Frame your mind to mirth and merriment which bars a thousand harms and lengthens life."--Shakespeare

Offline insights

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #7 on: January 28, 2014, 06:52:14 PM »
And yes the Zoloft made me bring myself to the hospital it was the most exrcutiating panic that lasted for 3 days

Do you remember the dose?

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 chris1234

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #8 on: January 28, 2014, 07:07:47 PM »
The dose of Zoloft was the lowest therapeutic Zoloft does and I was taking it in the evening which maybe could have had something to do with it ....... I took xanax before a game once and I noticed that my reaction time was MUCH slower than usual but again beggars can't be choosers id rather not anxious .... Even when my body is calm tho my mind is not where it needs to be I guess this takes time ? Even when I take a xanax it's like ok I calmed down but still I'm anticipating future problems , I guess it's so prominent in my mind that I would need to take it daily for maybe a week or two and I would see the difference ?
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Offline chris1234

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #9 on: January 28, 2014, 07:12:00 PM »
Maybe I'm depressed because it does have a negative sad base too it but my whole problem did start with anxiety .... I apologize if I sound retarted I'm just so clueless because even though it's been two years I still feel like in confused a bit
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Offline insights

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #10 on: January 28, 2014, 07:44:35 PM »
The dose of Zoloft was the lowest therapeutic Zoloft does

Zoloft comes in 25mg, 50mg and 100mg tablets. Usually, 50mg is the minimum therapeutic dose.

Was the 3 day anxiety episode with the first tablet, or had you been taking it for a while?

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 chris1234

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #11 on: January 28, 2014, 07:49:11 PM »
I took 25mg for a total of two days it happened right away
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Offline insights

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #12 on: January 28, 2014, 10:33:54 PM »
I took 25mg for a total of two days it happened right away

Then I suggest Celexa (citalopram) beginning on half a 10mg tablet and increasing the dose by 5mg every 2 weeks to 20mg/day. That is a small initial dose which shouldn't cause you too many problems. If you want to play it really safe, start off on only a quarter tablet for a week. You'll probably need a pill cutter to quarter the tablets accurately.

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 hikingchik63

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #13 on: January 29, 2014, 10:43:24 AM »
Whatever you go with, my advice is, start low, go slow. It's the only way Ive been able to start a med w/o alot of issues. good luck to u
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"Frame your mind to mirth and merriment which bars a thousand harms and lengthens life."--Shakespeare

Offline chris1234

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Re: SSRIS , TCAS , SNRIS, or MAOIS?
« Reply #14 on: January 29, 2014, 12:10:22 PM »
Yeah I will thank you... I'm getting extensive bloodwork again just to double check before I start the medicine
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