Posted by ChicagoKat on January 30, 2013, at 10:01:33
In reply to My Anxiety - the end of the road, posted by jono_in_adelaide on January 29, 2013, at 20:46:21
> I'll start by saying that I am very lucky, that my depression is very well controlled by the cocktail of reboxetine, sertaline and risperidone.
>
> However, I am still often bothered by disabeling anxiety, even when taking Xanax 1mg three times a day
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> Thinking about my options, i have come up with the following
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> - Drop sertaline and risperidone and substitute mirtazapine 30-45mg at night. I have never felt that SSRI's do much for me, and I'm wondering if mirtazapine might be better against anxiety than low dose risperidone (1.5mg at bedtime)
>
> - Drop sertaline and reboxetine and start nardil with or without nortriptyline. I'm sure Nardil would help the anxiety, but the side effects worry me, I get no side effects from my current drugs apart from a bit of dry mouth and delayed orgasm (sory if that was TMI)
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> - Change the 1mg alprazolam tid to 1mg clonazepam tid (clonazepam is both more potent and longer action, so I'd effectively be giving my self a dose increase of benzo) I worry that this might be the slippery slope to ending up like Elvis.
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> Any thoughts or comments or advice anybody could offer?I like options 1 or 2. I agree with you about the worry of benzos being a slippery slope, and I feel they really shouldn't be used for chronic anxiety.
I like the idea of trying mirtazapine first. You wouldn't have to do a washout, and there's no doubt it would help your anxiety. I get anxiety a lot, and mirtazapine was pure bliss to me. It's also great that it is a very effective antidepressant too.
Then,, if you couldn't tolerate the side effects of mirtazapine, or it just didn't work well for you, you could go ahead with a try of Nardil. Nardil's a pain, there's no doubt, what with the washouts and all the food and drug interactions. But it is an excellent anxiolytic and an excellent antidepressant. And tbh, the food interactions were not in the least difficults to deal with. It's just important you educate yourself about other meds that could interact with it - especially when a lot of docs (aside from pdocs) have no clue.
Good luck with your decision!
Kat
p.s. I personally find anxiety more difficult to deal with than depression, so don't feel at all as if you don't have a big deal problem. Chronic anxiety is definitely a big deal!
On a steady diet of soda pop and Ritalin
-Green Day
poster:ChicagoKat
thread:1036804
URL: http://www.dr-bob.org/babble/20130124/msgs/1036871.html