Guys I need help

[BearFan]

Right now I'm living alone and lost touch of some of my friends and having social anxiety makes it really hard to go out and meet people. I have been on prozac for many years, and recently started experimenting with new depression drugs, starting with Cymbalta (6 months), then pristiq and Effexor. Cymbalta was controlling anxiety but was having a lot of side effects. While Pristiq made me quite anxious at times and Effexor had quite bad sexual side effects. I'm thinking of restarting prozac, but it often makes me Jittery and just isn't working like it used to. Should I consider Lexapro (or something else)? I remember using Lexapro for about 6 months several years ago and felt calmer, although it seemed to make me slow minded. Have no idea what to do anymore and even the doc is confused...

[Vini Vidi Vici]

have you considered MAOIs such as Nardil or Parnate? it sounds like you tried tons of the typical SSRIs and SNRIs. the MAOIs work in a completely different way...and have fewer terrible side effects. the only hard thing is avoiding certain foods, but even so, its alot easier than dealing with many of the regular SSRI/SNRI side effects. you could also try some GABAergic drug such as Neurontin or Lyrica. Lyrica looks like it might be more effective for treating social anxiety...its licensed in Europe for the treatment of Generalized Anxiety Disorder. You could look into Mirtazapine (Remeron)....it has much fewer side effects than SSRIs, and is very effective at reducing anxiety. Many people have found success with Mirtazapine, and other 5ht2a/5ht2c antagonists. It sounds like you need to get completely off the SSRI/SNRI track..they all have very similar side effects. Nearly every antidepressant (except Wellbutrin) can be helpful for social anxiety. Stimulants like Ritalin and Adderrall can be very helpful, at least until you get tolerant to them. for some people, taking an SSRI/SNRI in combination with Wellbutrin will reduce the negative side effects of the SSRI, and provide greater relief of social anxiety.

[BearFan]

Haven't tried MAOIs except for that Emsam patch which was only a few days. I asked about Tricyclics, but heard they can have even more side effects than ssris. If you had to pick an ssri/snri, which was the least offender, which one would that be?

[Vini Vidi Vici]

Zoloft seemed to work the best for me, with fewer side effects than Paxil or Lexapro. It seemed to be more effective for my depression....but Paxil was definetly the strongest in terms of reducing social anxiety....however it had the most side effects. It wouldn't be right for me to recommend one SSRI over another, because nearly everyone experiences differing responses.

[db0255]

Originally Posted by BearFan

Haven't tried MAOIs except for that Emsam patch which was only a few days. I asked about Tricyclics, but heard they can have even more side effects than ssris. If you had to pick an ssri/snri, which was the least offender, which one would that be?

For me it was Prozac. Although no SSRI is the same for people. So dumb. A lot of people say Prozac doesn't do anything for their social anxiety, which was the complete opposite of what I had; I became an extravert, it was great...

[jim_morrison]

Originally Posted by db0255

For me it was Prozac. Although no SSRI is the same for people. So dumb. A lot of people say Prozac doesn't do anything for their social anxiety, which was the complete opposite of what I had; I became an extravert, it was great...

Yeah that never made much sence to me either, considering prozac is the only SSRI that's been shown to increases dopamine and noradrenaline in addition to serotonin, I would have been inclined to think that it would have edged out the other SSRI's for major depression (particualrly atypical) and SA. Although perhaps not for pure anxiety disorders such as panic disorder, GAD and OCD which it could possibly exacerbate. Personally I suffer from quite a few anxiety disorders, and I regard social anxiety as being an atypical anxiety disorder, because like I said it actually seems to respond well to catecholamine increase. Which is similair to atypical depression, but dissimilar to other anxiety disorders.

[BearFan]

From what I've read Prozac indirectly increases dopamine and noradrenaline, although not in huge amounts. Apparently Paxil has an afininity to noradrenaline, and Zoloft dopamine. If one liked lexapro for the antianxiety effect, what is best add-on (other than wellubtrin)? to get supposidely higher efficacy?

[jim_morrison]

Originally Posted by BearFan

From what I've read Prozac indirectly increases dopamine and noradrenaline, although not in huge amounts. Apparently Paxil has an afininity to noradrenaline, and Zoloft dopamine. If one liked lexapro for the antianxiety effect, what is best add-on (other than wellubtrin)? to get supposidely higher efficacy?

The high selectivity of both paxil and zoloft for the serotonin reuptake pump essentially make their secondary affinitys (noradrenaline and dopamine respectively) largely irrelevant, (unless your planning on giving it to your pet elephant who can handle 50 x the normal dose.)
Prozac is the only SSRI which has been shown to cause a robust and sustained elevation of dopamine and noradrenaline, and this is through a mechanism independent of reuptake. See here;

http://www.springerlink.com/content/p53vulufbqqyqy9r/

"Results: Fluoxetine, citalopram, fluvoxamine, paroxetine and sertraline similarly increased the extracellular concentrations of serotonin from 2- to 4-fold above baseline. However, only fluoxetine produced robust and sustained increases in extracellular concentrations of norepinephrine and dopamine after acute systemic administration."

[BearFan]

Of the MAOIs, Parnate seems to be favored, although I find it hard to believe this doesn't cause sexual problems like erection like all the other medications out there

[Vini Vidi Vici]

Originally Posted by BearFan

Of the MAOIs, Parnate seems to be favored, although I find it hard to believe this doesn't cause sexual problems like erection like all the other medications out there

dopaminergic drugs raise libido, and serotonergic ones decrease it and cause sexual dysfunction. SSRIs are strongly serotonergic. the MAOIs are strongly serotonergic, but also strongly dopaminergic, which is why they cause significantly less sexual dysfunction. of all the MAOIs, Parnate has been shown to be one of the most dopaminergic and most devoid of sexual dysfunction. if there are side effects related to such, they can subside in 2-3 weeks. i find that Parnate causes virtually no side effects of the sort that SSRIs did.

[db0255]

I wouldn't even look into what NTs that Prozac supposedly increases, cause for me, it wasn't really explainable that way. Why can I have a transformative experience with Prozac, and Remeron was just slightly OK. They both are 5-HT2C antagonist. IDK, Prozac, for me was light years past any other SSRI, which did jack****.

[jim_morrison]

Yeah it's a bit bizarre, I'm beginning to think that the only positive effect remeron is giving me is relief from my insomnia, but the side effects of next day grogginess and the weight gain is almost making me feel like its not worth it. The sad thing is that even though remeron doesnt do jack for my anxiety/depression it's probly been the most effective antidepressant for me, in the technical sence of the word 'antidepressant', just because it's given me some relief through the positive benefit of helping me sleep. But honestly most antidepressants i've tried actually make me feel worse, which may just be a rare reaction that I get, but I'm getting to the point where I'm sick of antidepressants, I don't think any will ever work for me.

[BusterBluth]

+1 on the only remeron benefit being that of a sleep aid (and keeping my appetite alive).

[jim_morrison]

What dose are you taking busterbluth? Coz I've found that reducing my dose by half to 15 mg still helped me sleep and kept the appetite, but with a moderate reduction in side effects of next day/lethary fatigue/foggy head.

[BusterBluth]

I just start splitting my 30mg tabs a few days ago to see if I notice any changes. Nothing really to this point. As I think you've probably seen in some of my other posts, this time of year seems to be my darkest.

[jim_morrison]

Sorry to hear that, I'm beginning to think that it's one of my darkest too, I've noticed my moods getting worse latly, I mean I've always had SA/Deperession, but only recently have I felt so dead inside that I've just lost all motivation and hope in life. Do you think mirtazapine might be contributing? I'm starting to wonder.