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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by tendency on April 14, 2005, at 14:52:09
i've started celexa for depression and anxiety. he thinks very highly of celexa for helping anxiety. is this true of SSRIs in general? i don't see the connection between serotonin and anxiety. thanks.
Posted by jessers11581 on April 14, 2005, at 14:58:32
In reply to pdoc bullsh!tting me about SSRI helping anxiety?, posted by tendency on April 14, 2005, at 14:52:09
Celexa helped me TREMENDOUSLY for about 3 years. Then it kind of stopped working. SSRI's are initially great for anxiety, in my opinion. The first one I used was Paxil, then I went to Celexa because Paxil was too sedating. Both worked wonders for my anxiety, panic, and OCD. But within the past couple of years, many of my symptoms resurfaced, so now I'm using an SNRI, which also affects norepinephrine. I wouldn't hesitate to give it a shot and later on, if you need to switch to something else, you can. Best of luck!
Posted by jessers11581 on April 14, 2005, at 15:00:46
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety?, posted by jessers11581 on April 14, 2005, at 14:58:32
> Celexa helped me TREMENDOUSLY for about 3 years. Then it kind of stopped working. SSRI's are initially great for anxiety, in my opinion. The first one I used was Paxil, then I went to Celexa because Paxil was too sedating. Both worked wonders for my anxiety, panic, and OCD. But within the past couple of years, many of my symptoms resurfaced, so now I'm using an SNRI, which also affects norepinephrine. I wouldn't hesitate to give it a shot and later on, if you need to switch to something else, you can. Best of luck!
One more thing--how long have you been taking it and at what dose? You may just need to give it a few more weeks to get the total effect. Are you having lots of anxiety right now? Have you ever used SSRI's before? If not, I would definitely say to stay on it for a bit and see if your opinion changes.
Posted by PM80 on April 14, 2005, at 15:05:27
In reply to pdoc bullsh!tting me about SSRI helping anxiety?, posted by tendency on April 14, 2005, at 14:52:09
Yes, SSRIs are commonly prescribed for anxiety. Here is one website that is specifically for people with anxiety by the anxiety disorders association of america:
http://www.adaa.org/AnxietyDisorderInfor/Medications.cfm
The link to the medications chart may be particularly helpful to you in answering your question.
Posted by Minnie-Haha on April 14, 2005, at 16:23:03
In reply to pdoc bullsh!tting me about SSRI helping anxiety?, posted by tendency on April 14, 2005, at 14:52:09
Cymbalta has helped me tremendously with my anxiety, though it took a couple weeks. Also, since I dropped from 60mg to 40mg it hasn't helped as well.
Posted by tendency on April 14, 2005, at 16:24:54
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety?, posted by jessers11581 on April 14, 2005, at 15:00:46
> One more thing--how long have you been taking it and at what dose? You may just need to give it a few more weeks to get the total effect. Are you having lots of anxiety right now? Have you ever used SSRI's before? If not, I would definitely say to stay on it for a bit and see if your opinion changes.
>
>thanks for the info. ive only been on it a week (15mgs) so ill definitely wait. just wasnt sure if SSRIs really are all that good for anxiety. until it kicks in doc gave me klonopin which does wonders for anxiety and ive noticed a number of other very beneficial side effects.
BTW, what does of celexa were you at?
Posted by tendency on April 14, 2005, at 16:26:12
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety?, posted by PM80 on April 14, 2005, at 15:05:27
thanks for the links. good info.
Posted by Minnie-Haha on April 14, 2005, at 16:46:52
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety?, posted by Minnie-Haha on April 14, 2005, at 16:23:03
Of course, technically Cymbalta is an SNRI, so maybe my response doesn't apply.
Posted by Phillipa on April 14, 2005, at 18:47:53
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety?, posted by Minnie-Haha on April 14, 2005, at 16:46:52
The first time I took one it helped along with xanax. After I stopped luvox worked but then they never did again. My chemistry changed I guess. Fondly, phillipa
Posted by panic_attacK on April 14, 2005, at 19:23:50
In reply to pdoc bullsh!tting me about SSRI helping anxiety?, posted by tendency on April 14, 2005, at 14:52:09
I take Lexapro, which is just like Celexa... and it has really helped my anxiety. I was so scared to start taking it, because I have tried several other SSRI's and they made my anxiety so much worse!!! i.e., Paxil, Prozac, etc.. I love Lexapro but it made me FAT#@!$%^&* So my doc is putting my on Wellbutrin to help the weight. She wants me to completely stop the Lexapro and just take Wellbutrin but Wellbutrin makes anxiety worse SO I am taking both.!
Posted by jessers11581 on April 14, 2005, at 21:11:17
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet, posted by tendency on April 14, 2005, at 16:24:54
> > One more thing--how long have you been taking it and at what dose? You may just need to give it a few more weeks to get the total effect. Are you having lots of anxiety right now? Have you ever used SSRI's before? If not, I would definitely say to stay on it for a bit and see if your opinion changes.
> >
> >
>
> thanks for the info. ive only been on it a week (15mgs) so ill definitely wait. just wasnt sure if SSRIs really are all that good for anxiety. until it kicks in doc gave me klonopin which does wonders for anxiety and ive noticed a number of other very beneficial side effects.
>
> BTW, what does of celexa were you at?
>
>I started at 20 mg. and worked up to 40. That was the highest I ever got, and I don't think that you would need much more than that. In fact, 20 mg. worked for almost 2 years. It was only a year ago that I had to begin raising the dose. And then it just kind of pooped out on me. Or at least I think that's what happened.
Posted by theo on April 14, 2005, at 22:59:06
In reply to pdoc bullsh!tting me about SSRI helping anxiety?, posted by tendency on April 14, 2005, at 14:52:09
> i've started celexa for depression and anxiety. he thinks very highly of celexa for helping anxiety. is this true of SSRIs in general? i don't see the connection between serotonin and anxiety. thanks.
The only SSRI I took that helped with anxiety was Paxil. Lexapro and Zoloft were horrible and amplified my anxiety x3. What's funny is I took Celexa a while back and had no problems, which makes me wonder why the experience was so different from Lexapro since it's suppose to be the new and improved Celexa.
Posted by mworkman on April 14, 2005, at 23:04:30
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety? » tendency, posted by theo on April 14, 2005, at 22:59:06
I think they mostly help with anxiety by numbing your emotions. If you are emotionaly flat then there really isn't much to get anxious about.
Posted by sukarno on April 15, 2005, at 4:49:31
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety?, posted by mworkman on April 14, 2005, at 23:04:30
SSRIs tend to be a crap shoot in the treatment of panic disorder. Not sure about regular anxiety or GAD, but in panic disorder the success rate is 30 to 50 percent according to a psychiatrist I know.
Usually SSRIs make anxiety worse in the beginning of treatment which many patients simply cannot deal with, so a benzodiazepine is often added to get them through this period.
In conclusion, SSRIs are best for anxiety *secondary* to depression. If anxiety is the primary problem and there is no associated depression, or depression is clearly secondary to anxiety, a sedating TCA (tricyclic antidepressant) such as imipramine, nortriptyline or amitriptyline may be useful as would be BuSpar or benzodiazepines.
The psychiatrist I know is also a neurologist and has primarily treated about 4000 panic disorder patients. From what he has seen, SSRIs have caused panic attacks in depressed patients who never experienced panic attacks before, but they don't seem to cause the disorder (panic disorder) itself.
SSRIs also have sexual side effects such as anorgasmia, and lowered or non-existant libido.
Also, the dependence which forms and results in "zaps", visual lag, tolerance ("poop-out"), nausea and vertigo upon discontinuation is something to consider.
SSRIs do work for many folks and I don't mean to knock these drugs in any way, but I feel the tricyclic antidepressants have been given an unfairly bad label since the advent of Prozac in the late 1980s.
Imipramine was once considered the "gold standard" in treating anxiety and depression. It remains an underutilised medication today since the SSRIs came about. However, it seems to have far fewer side effects (less sexual side effects and few to no withdrawal reactions upon discontinuation).
Most docs today are under the influence of drug company propaganda. They don't have time to do their own research, with the exception of a few.
Why go through torture when you can take something like TCAs which will work more quickly and are more sedating? I truly feel sorry for people who have pdocs who are forcing SSRIs down people's throats...especially when those people have had several negative reactions in the past to this class of drugs.
Pdocs need to learn empathy and make better use of existing drugs, instead of trying to push the so-called "latest and greatest" dope on their patients.
Those TV advertisements also need to be curtailed too, don't you think? The advertising is misleading and causes patients to influence their docs into Rxing Paxil, etc.
Psychiatrists today often spend little time with their patients and tend to overdiagnose conditions.
I apologise for this rant as it wasn't directed at any particular person or persons, but rather at the system which is easy to diagnose and easy to prescribe drugs which are new and whose mechanism of action and long-term safety are largely unknown.
Posted by ed_uk on April 15, 2005, at 10:18:29
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet, posted by sukarno on April 15, 2005, at 4:49:31
Hi!
>Those TV advertisements also need to be curtailed too, don't you think? The advertising is misleading and causes patients to influence their docs into Rxing Paxil, etc.
LOL.... See my post above- 'Funny things happen in the USA.'
It's so different here, drug companies are only allowed to advertise a restricted range of OTC meds to the general public. Advertising prescription-only drugs to the general public is illegal.
Advertising is strictly regulated, pharmaceutical companies are only allowed to spend a small amount of money on advertising their products.
Ed.
Posted by Spriggy on April 15, 2005, at 10:19:38
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet » sukarno, posted by ed_uk on April 15, 2005, at 10:18:29
Posted by irishcatholic on April 15, 2005, at 12:06:29
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet, posted by sukarno on April 15, 2005, at 4:49:31
Great post Sukarno
I know a drug rep quite well and he tells me some interesting stories. I wouldn't say most doctors are unethical but they are certainly "influenced" by the drug companies.
Posted by tendency on April 15, 2005, at 12:46:51
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet, posted by sukarno on April 15, 2005, at 4:49:31
> SSRIs tend to be a crap shoot in the treatment of panic disorder. Not sure about regular anxiety or GAD, but in panic disorder the success rate is 30 to 50 percent according to a psychiatrist I know.
..interesting. don't have panic disorder so that one does not concern me.
> Usually SSRIs make anxiety worse in the beginning of treatment which many patients simply cannot deal with, so a benzodiazepine is often added to get them through this period.this was the case with me. pdoc gave me 3 weeks worth of klonopin and until celexa kicks in. at this point im not sure i want to go off klonopin; it works great with (so far) no side effects.
> In conclusion, SSRIs are best for anxiety *secondary* to depression. If anxiety is the primary problem and there is no associated depression, or depression is clearly secondary to anxiety, a sedating TCA (tricyclic antidepressant) such as imipramine, nortriptyline or amitriptyline may be useful as would be BuSpar or benzodiazepines.
..this is good food for thought. im BPII tending towards depression but lately im thinking that anxiety may be the primary symptom. so..im not sure what to do. pdoc wants me on celexa for depression and anxiety and if mood gets wacky to put me on topamax. Maybe the TCAa would be worth investigating for me after a trial run of celexa.
<snip>
> SSRIs also have sexual side effects such as anorgasmia, and lowered or non-existant libido.
> Also, the dependence which forms and results in "zaps", visual lag, tolerance ("poop-out"), nausea and vertigo upon discontinuation is something to consider...im definitely concerned with this as i have some hormonal issues which are affecting my sexual functioning as well. how common is the 'poop-out' effect? other withdrawal symptoms seem tolerable if they're not that long drawn out.
<snip>
> Imipramine was once considered the "gold standard" in treating anxiety and depression. It remains an underutilised medication today since the SSRIs came about. However, it seems to have far fewer side effects (less sexual side effects and few to no withdrawal reactions upon discontinuation)...is imipramine a TCA?
<snip>
> Why go through torture when you can take something like TCAs which will work more quickly and are more sedating? I truly feel sorry for people who have pdocs who are forcing SSRIs down people's throats...especially when those people have had several negative reactions in the past to this class of drugs.
>
<snip>thanks for the great advice. more food for thought.
Posted by Gabbi-x-2 on April 15, 2005, at 14:49:26
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet, posted by sukarno on April 15, 2005, at 4:49:31
Posted by banga on April 15, 2005, at 16:29:26
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet, posted by sukarno on April 15, 2005, at 4:49:31
Yes, it is puzzling to me when pdocs go from one SSRI to another, to another, to another....often try over 4 of them, then perhaps effexor....before thinking of trying a TCA, or consider augmenting with a mood stablilizer. You only have to look at the withdrawal board to see that SSRIs are not innocuous as some pdocs try to say.
Certainly some do best on SSRIs, but not everyone....Signed Banga,
TCA advocate
(admittedly biased opinions)
Posted by ed_uk on April 16, 2005, at 15:11:28
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet, posted by banga on April 15, 2005, at 16:29:26
Hi,
>Yes, it is puzzling to me when pdocs go from one SSRI to another, to another, to another....often try over 4 of them, then perhaps effexor....before thinking of trying a TCA, or consider augmenting with a mood stablilizer.
Because they don't use their brain Lol!
This unfortunate SSRI 'merry-go-round' is particularly common in the UK. I am ready to step off!
Ed xxx
Posted by Phillipa on April 16, 2005, at 15:15:09
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet » banga, posted by ed_uk on April 16, 2005, at 15:11:28
Hi Ed! Does this mean you're planning on stopping yours? Fondly, Phillipa O
Posted by ed_uk on April 16, 2005, at 16:32:25
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet » ed_uk, posted by Phillipa on April 16, 2005, at 15:15:09
Hi P!
>Does this mean you're planning on stopping yours?
I've already come off my SSRI! My last post wasn't particularly well worded :-S
Ed xxxx
Posted by Phillipa on April 16, 2005, at 16:59:54
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet » Phillipa, posted by ed_uk on April 16, 2005, at 16:32:25
Wait a minute Ed. I thought you were still on lofepramine? Just Babbled you. Fondly, Phillipa OOO
Posted by ed_uk on April 16, 2005, at 17:09:02
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiet » ed_uk, posted by Phillipa on April 16, 2005, at 16:59:54
Hi P!
Lofepramine is a tricyclic antidepressant.
Ed xxx
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