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Author Topic: Quick question that most of you could answer  (Read 236 times)

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Offline chris1234

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Quick question that most of you could answer
« on: March 13, 2014, 12:46:18 PM »
I'm an In the throws of anxiety and need medication .... My question is that if SSRIS worked for people on both sides of my family does that mean that I have a good chance at an SSRI working for me? One of the reasons I'm asking is because I had a horrible adverse reaction to Zoloft last year when I tried it and I'm affraid to try others
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Offline Stressed Jumper

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Re: Quick question that most of you could answer
« Reply #1 on: March 13, 2014, 01:35:53 PM »
Every SSRI reacts differently with a person's unique body chemistry so it's sort of a trial and error game to find the right one for you.  I am on Zoloft (which is an SSRI) and the start up side effects were a beast but I pushed through.  They cleared up in 3 weeks and I have felt great ever since.  How long were you on Zoloft? (It can take up to 8 weeks at your therapeutic dose to take full effect.) What was your dosage when your side effects appeared?  What specific side effects did you get?  (I got every one in the book.)  In many cases with meds you will feel worse before you feel better but in my opinion its worth it in the end!
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Offline chris1234

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Re: Quick question that most of you could answer
« Reply #2 on: March 13, 2014, 02:33:11 PM »
After the second day I had to be brought to a hospital because I was in a panic attack that wouldn't turn off it was clearly an adverse reaction and not side effects I was vomitting and hadn't slept in 48 hours... My pupils were like the size of my eyeballs and the nurses thought I took I high dose of ecstasy but it was only 25mg of Zoloft .... It was pretty wild
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Offline insights

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Re: Quick question that most of you could answer
« Reply #3 on: March 13, 2014, 05:34:04 PM »
After the second day I had to be brought to a hospital because I was in a panic attack that wouldn't turn off it was clearly an adverse reaction and not side effects I was vomitting and hadn't slept in 48 hours

It may well have just been a very severe example of the usual initial SSRI side-effects. Most antidepressants will increase anxiety in the first few weeks and nausea is another common initial side-effect sometimes with vomiting.

Celexa (xitalopram) is the SSRI most people have the least problem with in terms of side-effects, which doesn't necessarily mean it won't bite, only that it may be less likely to. I suggest you start on no more than half a 10mg tablet, which would be about the equivalent of only 12.5mg Zoloft, and ramp it up by the same amount every 10-14 days until you get to 20mg/day. Having a benzodiazepine to control the extra anxiety would also make life much easier so ask your doctor for one.

If Celexa also causes a severe reaction then consider one of the older tricyclic antidepressants such as imipramine (Tofranil). They usually have milder initial side-effects, though more ongoing ones such as dry mouth and constipation.

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: Quick question that most of you could answer
« Reply #4 on: March 13, 2014, 06:42:11 PM »
That's scary to think I don't think my anxiety can increase much more lol..... Are TCAS just as effective as SSRIS?.... Also I was thinking maybe do a long half life benzo like valium for a month to get into a better place mentally and then get on an anti depressant I just don't like the whole addiction withdrawal thing
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Offline insights

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Re: Quick question that most of you could answer
« Reply #5 on: March 13, 2014, 07:54:46 PM »
Are TCAS just as effective as SSRIS?....

Yes. The TCAs haven't been mostly replaced by SSRIs because they were less effective, but because they are less safe in overdose, though recently Celexa and Lexapro have been found to have the same problem. Arguably, the TCAs are slightly more effective.

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Also I was thinking maybe do a long half life benzo like valium for a month to get into a better place mentally and then get on an anti depressant

Why not take both? Many take a benzodiazepine (BZDs) when starting antidepressants to help them get through the rough spots. BZDs do slightly delay antidepressant kick-in, but IMHO, the delay is better than not taking the antidepressant because of increased anxiety.

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I just don't like the whole addiction withdrawal thing

You won't get addicted to benzodiazepines, but you may become physically dependent to them if you take them daily for more than a month or two. Indeed, you're already dependent on the tiny amounts of BZDs occurring naturally in all foods and would be in serious trouble if you began eating a BZD free diet, which fortunately is almost impossible. You will also become dependent on antidepressants and many other psych meds. It means you must wean off them instead of quitting abruptly. This study illustrates the difference between addiction and dependence: Hirschowitz BI, (1998). Few taking BZDs would continue to if the consequences of doing so were the same.

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: Quick question that most of you could answer
« Reply #6 on: March 13, 2014, 10:46:12 PM »
Thanks Ian your very knowledgable and very helpful..... I heard elavil was good? I think I'm gonna see if I can get on that... Psychologically, I would be better off on a TCA
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Re: Quick question that most of you could answer
« Reply #7 on: March 14, 2014, 12:21:47 AM »
I heard elavil was good?

Amitriptyline is as good as any other as an initial choice. No antidepressant (AD) is intrinsically more effective than the others, but one or two may be for you, so you might need to switch ADs a few times to narrow down the best one for you. If you do need to switch then consider nortriptyline and desipramine which biased more toward norepinephrine than serotonin reuptake.

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Psychologically, I would be better off on a TCA

One big advantage the TCAs have is that they come in comparatively small dose tablets relative to the doses typically needed. Most have a minimum therapeutic dose of 75mg, yet are available in 10mg tablets which can be cut in half, so you could start on as little as 1/15th the minimum effective dose if you need to. OTOH, the minimum Celexa therapeutic dose is 20 mg and it also comes in a splittable 10mg tablet, so you smallest starting dose is a quarter of the minimum amount you need to take. This is a huge difference in terms of the potential severity of side-effects. Some SSRIs (and TCAs) are available in liquid form which would allow even smaller starting doses, but they can be less convenient and possibly more expensive.

Not that I'm suggesting you start a TCA on only 5mg. For most a 25mg starting dose with a 25mg increase every 5-6 days is quite comfortable, or maybe 10mg at first just to test your reaction if you want to be extra cautious.

Ian

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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