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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by tensor on February 21, 2013, at 9:39:23
I'm having problems with anxiety again after a failed benzo discontinuation. I'm also depressed. The only AD I take is mirtazapine 30mg. I'm looking for ideas, the TCAs are effective, atleast for anxiety. I have been thinking about amitrip but I don't know yet, are there any non-TCAs and non-APs that matches it in terms of efficacy? The TCA s/e are bothersome.
Also been looking at paroxetine, but it's over a decade I took it so I have no idea how effective it is but I hope it's better than the newer SSRIs.Any input appreciated.
/tensor
Posted by Phillipa on February 21, 2013, at 9:50:38
In reply to Mixed anxiety/depression meds, posted by tensor on February 21, 2013, at 9:39:23
Tensor why go off the benzos as now medicaire our insurance for older folks and disabled is now paying for them. As they now feel they are safe if not abused? As for paxil first ever took l0mg needed benzos with it. I guess my brain adjusted to it after three months. Took it two years and discontinued it. No longer needed it. Phillipa
Posted by tensor on February 21, 2013, at 9:53:19
In reply to Re: Mixed anxiety/depression meds » tensor, posted by Phillipa on February 21, 2013, at 9:50:38
> Tensor why go off the benzos as now medicaire our insurance for older folks and disabled is now paying for them. As they now feel they are safe if not abused? As for paxil first ever took l0mg needed benzos with it. I guess my brain adjusted to it after three months. Took it two years and discontinued it. No longer needed it. Phillipa
I suspect it causes depression, that's why. They are really cheap here so that's not a problem.
/tensor
Posted by b2chica on February 21, 2013, at 10:38:04
In reply to Mixed anxiety/depression meds, posted by tensor on February 21, 2013, at 9:39:23
for my light/medium anxiety i take gabapentin. it works great some days and not others, so its hit or miss with me so i augment with xanax.
but for others it works great.
Posted by tensor on February 21, 2013, at 11:31:07
In reply to Mixed anxiety/depression meds, posted by tensor on February 21, 2013, at 9:39:23
Did you or are you taking amitriptyline? I think I remembered reading that somewhere. What are your experiences with it? S/e, efficacy as AD and as anxiolytic.
Thanks,
tensor
Posted by enndub on February 21, 2013, at 12:45:19
In reply to Mixed anxiety/depression meds, posted by tensor on February 21, 2013, at 9:39:23
MAOIs are king for mixed anxiety/depression as far as i'm concerned. Definitely something to look into if you are unsuccessful on TCAs or can't tolerate the antichollinergic side effects.
Posted by tensor on February 21, 2013, at 12:49:47
In reply to Re: Mixed anxiety/depression meds, posted by enndub on February 21, 2013, at 12:45:19
> MAOIs are king for mixed anxiety/depression as far as i'm concerned. Definitely something to look into if you are unsuccessful on TCAs or can't tolerate the antichollinergic side effects.
We do not have maoi here.
/tensor
Posted by Phil on February 21, 2013, at 19:38:09
In reply to Phil, posted by tensor on February 21, 2013, at 11:31:07
Major chill pill, I was at 250 mg for 5 years. Good for anxiety, best sleep of my life till Seroquel. I even woke up refreshed on it and that never happens. Gained maybe ten pounds but exercised more during that period than ever before.
Constipation!! I know we should eat a proper diet, I ate Senokot the whole time I was on it. Sexual SE's pretty severe but high dose didn't help.
That was 30 years ago. My current doc, when I described some of my experiences on it thinks I was manic sometimes. Wrong DX.
My last doc tried to add it to a combo about 12 years ago when I had a crises, nothing.
For the time it was good. If I had tried most everything else with so-so results I would give it a shot. Very powerful stuff.
Posted by jono_in_adelaide on February 21, 2013, at 22:14:16
In reply to Mixed anxiety/depression meds, posted by tensor on February 21, 2013, at 9:39:23
mirtazapine and the tricyclics releive anxiety in the same way (blocking the 5HT2A and other 5HT receptors), so you might not gain much by switching to amitriptyline.
Is there any reason benzos are out for you?
Nardil could be a good option, it has antidepressant and anxiolytic actions.
Posted by tensor on February 22, 2013, at 0:52:37
In reply to Re: Mixed anxiety/depression meds, posted by jono_in_adelaide on February 21, 2013, at 22:14:16
> mirtazapine and the tricyclics releive anxiety in the same way (blocking the 5HT2A and other 5HT receptors), so you might not gain much by switching to amitriptyline.
>
> Is there any reason benzos are out for you?
>
> Nardil could be a good option, it has antidepressant and anxiolytic actions.We do not have maoi here, even if it could be imported, I wouldn't feel comfortable taking it since docs are not used to it.
The theory is that it may be the cause of my many relapses. I don't know if that is the case, but I would like to find out. The thing with benzos are, they are used for everything, the first-line med against many symptoms. If you need something for anxiety, BZD is the way to go.
What are you gonna use during a BZD withdrawal if you have a severe period of anxiety? You can't even use alcohol. My pdoc prescribed me pregabalin when I successfully withdrew from BZD a few years back, but he's *very* reluctant even talking about pregabalin now since many of his patients who are taking it for GAD are having a nightmare coming off it, body pain etc./tensor
Posted by tensor on February 22, 2013, at 0:58:26
In reply to Re: Phil » tensor, posted by Phil on February 21, 2013, at 19:38:09
> Major chill pill, I was at 250 mg for 5 years. Good for anxiety, best sleep of my life till Seroquel. I even woke up refreshed on it and that never happens. Gained maybe ten pounds but exercised more during that period than ever before.
So it gave you energy to exercise or like a kind of drive to do things (or both)? Would you say its anxiolytic properties are greater than that of Seroquel?
> Constipation!! I know we should eat a proper diet, I ate Senokot the whole time I was on it. Sexual SE's pretty severe but high dose didn't help.
Did you eat a lot of dietary fiber? I know I eat fiber rich food like crazy, you think it will help?
> That was 30 years ago. My current doc, when I described some of my experiences on it thinks I was manic sometimes. Wrong DX.
>
> My last doc tried to add it to a combo about 12 years ago when I had a crises, nothing.
>
> For the time it was good. If I had tried most everything else with so-so results I would give it a shot. Very powerful stuff.Thanks Phil, I will give it a try.
/tensor
Posted by Phil on February 22, 2013, at 7:53:31
In reply to Re: Phil » Phil, posted by tensor on February 22, 2013, at 0:58:26
> So it gave you energy to exercise or like a kind of drive to do things (or both)? Would you say its anxiolytic properties are greater than that of Seroquel?
>>I think that it just gave me the energy or optimism to exercise. I doubt if most people would say that. I was just on Amitrip, now on Seroquel, benzo etc, can't compare.
> Did you eat a lot of dietary fiber? I know I eat fiber rich food like crazy, you think it will help?>>Yeah, anything other than the way I ate.
> Thanks Phil, I will give it a try.
>
> /tensorOK
Posted by jono_in_adelaide on February 24, 2013, at 20:27:15
In reply to Re: Mixed anxiety/depression meds, posted by jono_in_adelaide on February 21, 2013, at 22:14:16
In that case I'd look at one of the following
* Adding an SSRI to your mirtazapine
* Adding a low dose atypical antipsychotic (say risperidone 1mg at night) to your mirtazapine
* Adding buspirone 15-30mg twice a day to your mirtazapine
* Ading a long acting benzo (diazepam, chlorazepate or chlordiazepoxide) to your mirtazapine
Posted by tensor on February 24, 2013, at 20:48:55
In reply to Re: Mixed anxiety/depression meds, posted by jono_in_adelaide on February 24, 2013, at 20:27:15
I decided to go with amitriptyline, I maybe have a shot at getting my depression under control also.
Thanks anyway.
> In that case I'd look at one of the following
>
> * Adding an SSRI to your mirtazapine
>
> * Adding a low dose atypical antipsychotic (say risperidone 1mg at night) to your mirtazapine
>
> * Adding buspirone 15-30mg twice a day to your mirtazapine
>
> * Ading a long acting benzo (diazepam, chlorazepate or chlordiazepoxide) to your mirtazapine
Posted by Meltingpot on February 26, 2013, at 9:55:14
In reply to Mixed anxiety/depression meds, posted by tensor on February 21, 2013, at 9:39:23
Hi Tensor,
Why won't you take APs for the anxiety? Zyprexa really helps me when I'm desperate.
Re the Seroxat, Seroxathas helped my anxiety a lot (touch wood) but I had to take 40mg for it to take the anxiety away. You might be different though.
Clomipramine (a tricyclic) helped my anxiety, initially I had a lot of anxiety but after 5 weeks and getting the dose up to 150mg (I think) it helped a lot. Made me very tired though but being tired is a hell of a lot better than being suicidally anxious.
Denise
Posted by tensor on February 26, 2013, at 10:14:17
In reply to Re: Mixed anxiety/depression meds, posted by Meltingpot on February 26, 2013, at 9:55:14
> Hi Tensor,
>
> Why won't you take APs for the anxiety? Zyprexa really helps me when I'm desperate.
>
> Re the Seroxat, Seroxathas helped my anxiety a lot (touch wood) but I had to take 40mg for it to take the anxiety away. You might be different though.
>
> Clomipramine (a tricyclic) helped my anxiety, initially I had a lot of anxiety but after 5 weeks and getting the dose up to 150mg (I think) it helped a lot. Made me very tired though but being tired is a hell of a lot better than being suicidally anxious.
>
>
> DeniseI took Seroquel but quit over a month ago. I wanted less meds onboard but I wasn't prepared for the anxiety that followed the BZD withdrawal. I now take amitrip 75mg and it's helping. I will stick with it for a while, as I'm now tapering clonazepam again. I was on clomipramine in the past and at 150mg it was effective for anxiety but made me impotent and anorgasmic.
/tensor
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