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I just started a tiny dose of Trintellix 2.5 mg for 6 days now. It's making me super sleepy..... even though the starting recommended dose is 10MG. I am sensitive to meds and am also afraid of side effects.  I have tried Celexa, Lexepro, (didn't do anything and made my anxiety worse). Tried prozac (huge weight gain 20+pounds & had sleep issues).  Cymbalta was okay, but had severe stomach pains! I had to quite after 8 weeks into it. Pristiq was so energizing, which made me irritable and anxious.  I tried effexor for two weeks and had panic attacks- it was the immediate release tablets.  Maybe the extended release would have been better?   I also tried nortriptyline which was an add on medication- made me irritable. I've also tried Gabapentin which made me feel anxious when i upped my dose. I couldn't handle the sleepiness either.  What should i try next? Is it normal for all these meds to increase anxiety at first???? Will I eventually get over that hump.

Klonopin and/ or xanax works wonder, but probably won't be a long term option. I am dependent on Klonopin right now.

 

What helped you?

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I’m not the right one to give a new med suggestion (there are others here who are better equipped than I am), but start up side effects, including anxiety, are typical of a lot of medications.  There’s variation among how much you have to stick it out t see if it would go away.  But I wouldn’t immediately cross it off if it causes a problem initially—that’s usually why a benzo is given during the start up period.

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Maybe it's time to add on the antidepressant antipsychotics... Rexulti, abilify, seroquel, (maybe latuda- but that's more for BP) and sometimes Vraylar. My personal favorite was rexulti. Seroquel can be very helpful for anxiety but is really sedating. As said above start up anxiety is very common. I usually mention the newest SNRI fetzima just cuz of its unique action, but then I always add the disclaimer that it's definitely a crapshoot love/hate thing. 

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Based on your description and my experience... and only that:

Lexapro (pure SSRI) - doesn't work
Prozac (SSRI with 5HT2C antagonizm) - weight gain. 5HT2C antagonism is generally good for mood, but increases appetite.
Pristiq/Effexor (SNRI) - anxiety.

How much Effexor were you on?
It tends to have a stronger effect on norepinephrine above ~200mg, which can sometimes cause more anxiety.

A low dose antipsychotic may allow reducing the dose the antidepressant and improve anxiety on its own.
I had good experience (anxiety-wise) with Risperidone and with Abilify. The latter has less side effects.

My 2 cents

 

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I was on the lowest dose of Effexor and it was the immediate release tablets. I’m considering trying that for a longer period of time since it’s indicated for anxiety . I was only on it for two weeks. 

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47 minutes ago, Ethansmom said:

I was on the lowest dose of Effexor and it was the immediate release tablets. I’m considering trying that for a longer period of time since it’s indicated for anxiety . I was only on it for two weeks. 

Yeah that's a reasonable idea, it's so frustrating how much patience antidepressants take 

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THe doctor wants me to go up to 5mg on trintellix this weekend . I’m not ready yet. I will give it another few days and go up when I’m readt

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I’ve always wondered about seroquel. Just wondering if it would stop the anxious thoughts and Panic attacks?

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Posted (edited)
9 hours ago, Ethansmom said:

I’ve always wondered about seroquel. Just wondering if it would stop the anxious thoughts and Panic attacks?

Seroquel is also an AAP.

It may work for you, just note that it is considered one of the more sedating of AAPs and you mentioned that you have a problem of becoming too sleepy from meds.
(In my pdoc's words, when I asked about it: "you will sleep all day")

Anyway, if it were me I would first get to the right dose of current meds before adding others. Otherwise it may be harder to know which of them did what.

Edited by HydroCat

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My son has terrible anxiety. Was on seroquel for about a year and gained over 70 lbs. Now on effexor and klonopin. Doing better, but still has issues.

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Pamelor used to be a drug of choice for anxiety and panic/agoraphobia disorder.  I was on that for 30 years and did wonderfully on that drug.  Considering going back on it again.

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I will agree with @looking for answers that Paxil is a good SSRI for anxiety; however, you've already tried 3 SSRIs and 3 SNRIs (why in the world you were put on Effexor IR tablets instead of the XR capsules is beyond me...). You could try it if you wanted, but I think it's time for either some augmentation (as some have suggested), or some 2nd-line medications.

Second-line medications include the tricyclic antidepressants (of which you've tried one, Pamelor), and the MAOIs. The tricyclic you tried, Pamelor, is a secondary amine, the group of TCAs of which work more on norepinephrine than serotonin, which is probably why it caused agitation in you. My guess is that you would need a tertiary amine TCA, which tend to work more on serotonin than norepinephrine. The thing is, a majority of them produce active metabolites which are secondary amines that work more on norepinephrine, so you will get a 2-in-1 action with the tertiary TCAs.

Tricyclics:

  • Elavil (amitriptyline) is one medication that is very, very commonly used; however, it just so happens to produce nortriptyline (Pamelor) as an active metabolite, so that might not be a good match for you. It has pretty potent anticholinergic, antihistaminergic, and 5-HT2A/2C antagonism. Nevertheless, it just might be worth mentioning to your pdoc. I've never taken this as an antidepressant, just as a sleep aid. I was prescribed 25 mg, but it didn't work, so I took 150 mg, then my pdoc got onto me for it... lol.
  • Tofranil (imipramine) is another that is commonly used for people with anxiety. It does produce desipramine as an active metabolite, which is I believe the most potent norepinephrine reuptake inhibitor on the market currently. It has relatively low anticholinergic effects, but somewhat potent antihistaminergic effects. This literally was a nightmare for me. It gave me nightmares. I wasn't on this long. Ymmv.
  • Sinequan (doxepin) is basically an antihistamine, not so much an antidepressant. IMO, you'd be wasting your time with this one, unless you respond well to antihistamines with your anxiety, in which case I'd recommend to just buy some generic Walmart brand clorpheniramine OTC because it's much, much cheaper and does the same thing (it won't be as potent an antihistamine, but chlorpheniramine has slight SNRI properties itself, probably not as potent as doxepin, but it would be similar).
  • Anafranil (clomipramine) is considered the "gold standard" SNRI because of its extraordinarily potent serotonin reuptake inhibition and its active metabolite's remarkably potent norepinephrine reuptake inhibition which increases in concentration as the dose increases. This is commonly used for cases of OCD that don't respond to the SSRIs like Luvox, Prozac, Zoloft, etc. My personal experience with Anafranil was nightmarish. It made me suffer worse depression and anxiety and gain almost 30 lb, but ymmv!

MAOIs:

  • Parnate (tranylcypromine) is unique among the MAOIs in that it is not only related to amphetamine, but is actually considered a substituted amphetamine. It can be really quite stimulating, yet soothing for people with anxiety. It acts not only as an MAOI but also as a releasing agent of norepinephrine and dopamine. Its dopamine releasing potency is about 1/10th that of dextroamphetamine. It is the least likely to induce weight gain; in fact, it may induce weight loss for some patients. It is, however, the most likely to induce hypertensive crisis, and, ironically, postural hypotension. I loved Parnate; it melted my depression and anxiety away, although I did gain a significant amount of weight on it paradoxically, and it did fizzle out from working very quickly.
  • Nardil (phenelzine) is very commonly used for people with panic disorder because it actually increases the amount of GABA available in the CNS by inhibiting GABA-T (GABA transaminase). It also mimics amphetamine-like activity by metabolizing into phenethylamine (PEA), which is also a norepinephrine-dopamine releasing agent like amphetamine, although with markedly different pharmacokinetics such as shorter duration of action (also lower potency I believe). The issue with Nardil, as a hydrazine-class MAOI, is that it has a tendency to, (1) cause rapid and abundant weight gain (although some say not as much as the tertiary amine TCAs), and (2) cause vitamin B6 deficiency which can lead to neuropathy (reversible with vitamin B6 supplementation). Nardil can be sedating to some or stimulating to others. I have no personal experience with Nardil. Also, Nardil has a propensity to cause liver toxicity.
  • Emsam (selegiline transdermal system) is a transdermal patch worn on the skin that delivers a steady supply of the medicine directly into the blood stream. It bypasses first-pass metabolism in the gut, thereby mitigating MAO-A metabolism in the gut which would normally produce the infamous "cheese reaction" if high tyramine food were to be ingested (it would interact with MAO-A in the gut). Selegiline is also related to amphetamine; in fact, it metabolizes into L-amphetamine and L-methamphetamine; however, the transdermal patch actually lowers the amphetamine byproducts delivered into the system that would normally be produced by the oral tablet/capsule despite the patch delivering a much higher dose than the oral dosage form. Emsam can be very stimulating to most people, and personally, I didn't find it helpful for my anxiety. IME, Emsam didn't work at all for anything, but I think that's because I was underdosed. My pdoc wouldn't go past 9 mg/24 hr patch for some reason... She said 12 mg was too high and refused to prescribe it.
  • Marplan (isocarboxazid) is a hydrazine MAOI related somewhat to Nardil. Marplan hasn't been as thoroughly studied as Nardil has. It doesn't seem to have the same propensity to cause weight gain, vitamin B6 deficiency, or liver toxicity as Nardil does. It's brand-name as they apparently took it off the market in the 90's, then re-released it recently for some dumb reason. Some insurance companies don't even cover it, or if your insurance company is like mine, they only cover half the list price... Personally, Marplan was okay. It did make me a little irritable, didn't help with anxiety much, didn't help much with depression really... Only for a week or two maybe, but that was it. It was very expensive. I didn't think it was worth it. I did lose some of the weight I gained on Parnate though.

Augmenting agents:

  • Seroquel (quetiapine): This is an antihistamine... Read this. No, really, read it. If you respond well to antihistamines with your anxiety, go for it. But I think chlorpheniramine would be better, and you won't sleep all day.
  • Zyprexa (olanzapine): If weight gain and the possibility of diabetes aren't an issue for you, a low dose (temporarily) of Zyprexa might be a good fit.
  • Abilify (aripiprazole): Abilify can help anxiety while not sedating; in fact, it can be stimulating. My best friend who tried it recently though was so sedated on it that he couldn't function... plus he gained like 13 lb on it in two weeks, so he had to quit it, which is really odd. It's not really known for causing weight gain that often. It actually helped me lose weight.
  • Trileptal (oxcarbazepine): An anticonvulsant which may help with anxiety -- this does wonders for my anxiety. It might cause a little ataxia and word-finding problems in higher doses, but it really does miracles for me. No weight gain or anything. May have a little antidepressant effects too even though it's most commonly used for mania in bipolar disorder.
  • Keppra (levetiracetam): Another anticonvulsant which is sometimes (not that commonly) used for anxiety. It does carry a risk for causing the "Keppra rage," which is exactly what it sounds like. Weight neutral, may cause some weight loss.
  • Topamax (topiramate): Another anticonvulsant which may help anxiety. Usually used for migraines when not used for epilepsy. It's not really a matter of if you will get cognitive side effects, it's a matter of you will get cognitive side effects... hence why people call it "Dopamax." The degree to which you get these side effects depends on your starting dose and the rate of titration. Weight loss is actually a very common side effect. Watch out for kidney stones--stay very well hydrated.

This is all I could think of off the top of my head. If I think of anything else I'll reply with more. :)

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I kno someone who did well on low dose risperdal. Also many here have had luck with stelazine 

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5 hours ago, Iceberg said:

I kno someone who did well on low dose risperdal. Also many here have had luck with stelazine 

I second Stelazine! :) Although I don't think it's a first-line agent, it definitely worked miracles for me.

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