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Re: Dr. Bob & others - your opinion re SSRIs

Posted by paul frank on February 24, 1999, at 18:43:04

In reply to Re: Dr. Bob & others - your opinion re SSRIs, posted by Matt on February 24, 1999, at 1:55:02

> > I suffer from GAD with some symptoms of depression. My doc first put me on prozac 20mg. After 4 weeks, the depressive symptoms had improved, but the anxiety continued, so she switched me to Zoloft. I have been at 100 mg for two weeks now and depressive symptoms have not returned, but I remain anxious and worried. I have had minimal side effects from both drugs, other than excessive nervousness. In your opinion, if Zoloft doesn't work, should we go to a third SSRI (my doc says she will next try Paxil) or would it make more sense to switch to another class of anti-depressant (ie Effexor? Serzone?) My main problem has always been GAD.
> >
> > Thank you for your response.
> Have you considered Remeron? It is terrific on anxiety. There is more weight gain at 15mg than at 30mg. All the SSRIs can be quite helpful for GAD. Prozac helped me significantly. New studies on Celexa are showing that it is very good with anxiety.
> If I may say, 4 weeks on an SSRI probably isn't a sufficently long trial to determine if it will help with your GAD. Also, if anxiety is your main problem, why not consider a benzodiazepine like Klonopin in addition to the SSRI. This would have the advantage of allowing you to avoid some of the weight gain that probably would come with Remeron. Also, once the depression has been gone for a sufficiently long period of time, you might consider the benzodiazepine as a better long-term solution to your GAD.
> I'm not a Serzone fan, and I'm not the only one who feels this way. I think that BM-Squibb is quite good at marketing Serzone, though. (Somehow one always hears this drug mentioned in connection with anxiety; I'm really curious if any double blind studies have been done comparing it to SSRIs and TCAs as far as anxiolytic effects go.)
> Matt


Thanks for your comments. Its nice to meet another individual with GAD who, like myself, has done some research and wants to be part of the treatment process.

Remeron is quite new and I live in a community where the medical establishment tends to be somewhat conservative. I agree with you that my doc did not give Prozac a fair chance. If the Zoloft doesn't work, do you think Paxil would be worth a try in light of the fact that 2 SSRIs didn't work? In your experience, how long does it take for an SSRI to kick in for GAD?

Every time I take Klonopin (or any other benzo for that matter), I have a favourable response to it. Not only does it eliminate my anxiety, but it also appears to lift my mood (which is probably lousy because of the GAD) and I enjoy my life again. However it will sometimes appear to lose its effectiveness after only an hour or so. The effects appear to last longer if I take it with food. Perhaps my dose is too low (1.0 mg in AM for the whole day - I am a 190lb male)). I would love to switch to Klonopin long term if I weren't so paranoid about the whole dependency thing. I don't take nearly as much of it as I probably should.

I am certainly hopeful Zoloft works for my GAD and I can once again experience some happiness in my life. However, I am quite concerned about what I have heard regarding "personality changes" with the SSRIs. With all my faults, I am still me and want to remain me - I simply want the anxiety, worry, etc to be brought under control - and nothing else. Do any of the people you know who have responded to the SSRIs, SNRIs and/or the older TCAs feel the meds altered who they were, or just relieved their symptoms?

Feel free to contact me if you would like to share experiences or if you would like my perspective on your particular struggles with GAD.





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