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Re: Best non-MAOI for these symptoms?

Posted by ed_uk2010 on February 25, 2012, at 12:38:07

In reply to Best non-MAOI for these symptoms?, posted by davidla on February 25, 2012, at 10:55:16

>I know everyone responds differently - I am just looking for the med with the best chance of working even if the advantage is slight.

> SSRI options in order?
> 1. Effexor XR (venlafaxine)
> 2. Cymbalta (Duloxetine)
> 3. Paxil (Paroxetine)

I do not know what you've tried so far, but I would start out with sertraline (Zoloft), citalopram (Celexa) or if affordable escitalopram (Lexapro). Effexor, Cymbalta and Paxil tend to cause more adverse effects (and more severe withdrawal symptoms) - these are not generally first-line medications.

>Best augmentation?
> 1. Klonopin (for anxiety)
> 2. Anafranil (for OCD)

Klonopin is effective for most types of anxiety, but is not reliable for OCD. For me, it causes more adverse effects than SSRIs. Memory loss, sedation, dependence and disinhibition can be a problem. Other people tolerate benzos better than SSRIs. Benzos can be an effective add-on to SSRIs for severe anxiety disorders. Klonopin can make depression worse (or better), depending on the individual.

Clomipramine (Anafranil) is a very potent antidepressant and anxiolytic. It is not an 'augmenting' agent, clomipramine would be your primary medication. Clomipramine tends to cause more side effects than SSRIs and is therefore not a first-line drug. If SSRIs are not effective, clomipramine could be a suitable choice. There is no doubt that clomipramine is a very strong medication.

 

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poster:ed_uk2010 thread:1011520
URL: http://www.dr-bob.org/babble/20120221/msgs/1011536.html