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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by johnj on October 7, 2007, at 12:11:53
Can somebody explanin why ssri can make anxiety much worse?
I had bad luck on paxil and luvox even at low doses. I was wondering if celexa might be different. The reason is that I found it is metabolized different in the liver and wondered if that would make a difference or is it just plain dopamine or something else? Thank you.
johnj
Posted by Phillipa on October 7, 2007, at 12:43:47
In reply to Ssri anxiety mechanism?, posted by johnj on October 7, 2007, at 12:11:53
Johnny I wish I knew but I can tolerate luvox at low doses with benzos. Hope someone has the answer. Phillipa
Posted by Racer on October 7, 2007, at 13:51:19
In reply to Ssri anxiety mechanism?, posted by johnj on October 7, 2007, at 12:11:53
Serotonin is one of several neurochemicals involved in anxiety, and the simplistic explanation is that increasing serotonin decreases anxiety -- but that is simplistic, because in other cases, excessive serotonergic activity can be involved in increased anxiety. That seems to be the explanation for increased anxiety during the adjustment phase of SSRI treatment.
Additionally, it's always worth remembering that individual neurotransmitters are most likely not the answer to any psychiatric disorder. It seems that the ratios are what matter -- finding the sweet spot between, say, dopamine and serotonin is probably more important than increasing the levels of either one.
Notice, though, I said "adjustment phase." The initial increase in anxiety from serotinergic medications does pass. If you can get through the first two or three weeks, you should find that SSRIs markedly decrease anxiety. Starting at ultra-low doses may not help with this, by the way. If you can start at the standard starting dose, and titrate up to a therapeutic dose on a standard schedule, you'll often find that the improvement in anxiety happens much faster.
Although it may not seem like it, based on my own experiences and those of people I've known who've also experienced significant anxiety problems on starting new medications, a lot of the anxiety actually seems to be psychological. Yes, it's certainly exacerbated by the medications themselves, since they start mucking about with the ratios between the various neurotransmitters pretty quickly. That will certainly affect anxiety levels, but I know in my own case at least that my own psychological reaction to starting these medications has an awful lot to do with my initial anxiety in response ot them.
The good news is that, if you can get through the adjustment phase and get up to an adequate therapeutic dose, SSRIs really are good at reducing anxiety. In fact, for some people they're *too* good at it, leading to a sort of apathy. In any case, if anxiety is a big problem for you, it's well worth trying to get through that start up phase, so that you can find out whether SSRIs will help you.
Posted by Phillipa on October 7, 2007, at 20:00:51
In reply to Re: Ssri anxiety mechanism? » johnj, posted by Racer on October 7, 2007, at 13:51:19
Never happened to me except luvox once and low dose l0mg of paxil with a benzo and lopressor. Took cymbalta first time at 60mg with benzo too and did nothing for either anxiety or depression was over three months and second time could not handle it at all felt like my head would explode. I too agree with stargazer if the med is not the right one and is causing more anguish than help it is not the right one for you. My experience of course. And I do hope you find one that works like that for you. Never had any apathy either wonder why? Phillipa
Posted by johnj on October 7, 2007, at 21:24:04
In reply to Re: Ssri anxiety mechanism? » johnj, posted by Racer on October 7, 2007, at 13:51:19
Racer:
Thank you for such a long response. The problem with luvox for me was that it wreaked my sleep so much that I was getting only 2 hours and that was at a very low dose. I guess I could have taken it in the morning. The increased heart rate was unbearable and I wonder if celexa might be a good one to try. I have anxiety and ocd stuff and generally low doses work well for me.
Paxil was a nightmare and I was spaced out and freaked out.
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